Osteoporosis

Question 1

2. Which of the following is an example of a primary
   prevention activity in a 76-year-old woman with
   osteoporosis?
   A. bisphosphonate therapy
   B. calcium supplementation
   C. ensuring adequate illumination in the home
   D. use of a back brace

Answer 1

C. ensuring adequate illumination in the home

Question 2

157. All of the following are common sites of fracture in
patients with osteoporosis except:
A. the proximal femur.
B. the distal forearm.
C. the vertebrae.
D. the clavicle.

Answer 2

D. the clavicle.

Question 3

158. Osteoporosis is more common in individuals:
     A. with type 2 diabetes mellitus.
     B. on long-term systemic corticosteroid therapy.
     C. who are obese.
     D. of African ancestry.

Answer 3

B. on long-term systemic corticosteroid therapy.

Question 4

159. Clinical disorders that increase the risk for
     osteoporosis include all of the following except:
     A. rheumatoid arthritis.
     B. celiac disease.
     C. hyperlipidemia.
     D. hyperprolactinemia.

Answer 4

C. hyperlipidemia.

Question 5

160. Osteoporosis is defined as having a bone density more than standard deviation(s) below the average
bone mass for a healthy young adult.
A. 1
B. 1.5
C. 2.5
D. 4

Answer 5

C. 2.5

Question 6

161. The preferred screening test for osteoporosis is:
A. quantitative ultrasound measurement.
B. dual-energy x-ray absorptiometry.
C. qualitative CT.
D. wrist, spine, and hip radiographs.

Answer 6

B. dual-energy x-ray absorptiometry.

Question 7

162. Osteoporosis prevention measures include all of the following except:
     A. calcium supplementation.
     B. selective estrogen receptor modulator use.
     C. vitamin B6 supplementation.
     D. weight-bearing and muscle-strengthening
     exercises.

Answer 7

C. vitamin B6 supplementation.

Question 8

163. All of the following are common signs of osteoporosis except:
     A. gradual loss of height with stooped posture.
     B. hip or wrist fracture.
     C. increase in waist circumference.
     D. patient report of back pain.

Answer 8

C. increase in waist circumference.

Question 9

164. What is the recommended daily calcium intake for
women older than 50 years of age?
A. 800 mg
B. 1000 mg
C. 1200 mg
D. 1500 mg

Answer 9

C. 1200 mg

Question 10

165. Nondairy sources of calcium include all of the
following except:
A. tofu.
B. spinach.
C. brown rice.
D. sardines.

Answer 10

C. brown rice

Question 11

166. Long-term bisphosphonate treatment (i.e., >5 years) has been associated with:
A. atypical fractures.
B. hyperprolactinemia.
C. osteoarthritis.
D. bone marrow suppression.

Answer 11

A. atypical fractures.

low-trauma atypical femoral fractures have been associated with long-term use of bisphosphonates (i.e., >5 years). Pain in the thigh or groin area often precedes these fractures

Question 12

167. The use of calcitonin to treat osteoporosis has been associated with an increased risk of:
A. type 2 diabetes.
B. rheumatoid arthritis.
C. malignancy.
D. systemic lupus erythematosus.

Answer 12

C. malignancy.

Question 13

168. Which of the following patients would be an
     appropriate candidate for treatment with teriparatide
     (Forteo®)?
     A. a 54-year-old woman with osteopenia
     B. a 64-year-old woman with bone mineral density
     (BMD) T-score of –2.5 and prior hip fracture
     C. a 67-year-old man with a BMD T-score of –1
     D. a 72-year-old woman who has a stable BMD
     T-score of –1.5 with bisphosphonate treatment
     for the past 3 years

Answer 13

B. a 64-year-old woman with bone mineral density

(BMD) T-score of –2.5 and prior hip fracture

Question 14

169. The bisphosphonate therapy given as an annual
infusion is:
A. risedronate.
B. zoledronic acid.
C. ibandronate.
D. denosumab.

Answer 14

B. zoledronic acid.

Question 15

170. In counseling a postmenopausal woman, you advise her that systemic estrogen therapy users can possibly experience:
     A. an increase in breast cancer rates with long-term use.
     B. reduction in high-density lipoprotein cholesterol.
     C. a 10% increase in bone mass.
     D. no change in the occurrence of osteoporosis.

Answer 15

A. an increase in breast cancer rates with long-term use.

Question 16

171. When counseling a patient taking a bisphosphonate such as alendronate (Fosamax®), you advise that the medication should be taken with:
A. a bedtime snack.
B. a meal.
C. other medications.
D. a large glass of water.

Answer 16

D. a large glass of water.

To minimize the risk of drug-induced
esophagitis, patients taking an oral bisphosphonate should be cautioned to take the medication in the morning with a full glass of water. At least 30 minutes must elapse before food, other liquids, or medications are ingested. In addition, patients should remain upright for at least 1 hour.

Question 17

RISK FACTORS FOR OSTEOPOROSIS

Answer 17

Lifestyle factors (e.g., physical inactivity, low calcium intake, alcohol abuse)

Genetic factors (e.g., cystic fibrosis, Gaucher disease)
Hypogonadal states (e.g., androgen insensitivity, hyperprolactinemia)

Endocrine disorders (e.g., diabetes mellitus, adrenal insufficiency)

Gastrointestinal disorders (e.g., celiac disease, inflammatory bowel disease)

Hematologic disorders (e.g., multiple myeloma, leukemia)

Rheumatologic and autoimmune disorders (e.g., rheumatoid arthritis, lupus)

Central nervous system disorders (e.g., epilepsy, multiple sclerosis)

• Miscellaneous other conditions and diseases (e.g., AIDS/HIV, congestive heart failure)
• Use of certain medications (e.g., long-term corticosteroid medications, some anticonvulsants, thyroid hormones)

Question 18

RECOMMENDATIONS FOR OSTEOPOROSIS SCREENING

Answer 18

• Women aged 65 and older and men aged 70 and older, regardless of risk factors
• Younger postmenopausal women, women in the menopausal transition, and men aged 50 to 69 with clinical risk factors for fracture
• A woman or man after age 50 who has broken a bone
• Adults with a condition (e.g., rheumatoid arthritis) or taking a medication (e.g., long-term glucocorticoid) associated with low bone mass or bone loss

Question 19

AVAILABLE SCREENING TESTS FOR OSTEOPOROSIS

Answer 19

Dual-energy x-ray absorptiometry (DXA) of the hip and spine. Using DXA to measure bone density of the hand, wrist, forearm, and heel also seems to detect women who are at increased risk for fracture
• Other tests to measure bone mineral density: Ultrasound, radiographic absorptiometry, single-energy x-ray absorptiometry, peripheral DXA, and peripheral quantitative computed tomography

Question 20

OSTEOPOROSIS TREATMENT

Answer 20

All to be used with appropriate calcium and vitamin D supplementation
• Bisphosphonates, such as alendronate, ibandronate, risedronate, and zoledronic acid
• Other antiresorptive medications including selective estrogen receptor modulators (SERMs), such as raloxifene, calcitonin, estrogen, and RANK ligand inhibitor (denosumab)
• Bone-forming (anabolic) medications such as teriparatide (parathyroid hormone)