4.5 of 93 Ratings
An 85-year-old woman presents with severe back pain and the CT shown in Figure A. Her history is notable for prior vertebral compression fractures for which she underwent a cement augmentation procedure. She has been on bisphosphonates for the last 5 years, without improvement of her osteoporosis. She has no history of malignancy. What is the mechanism of action of the medication that should be prescribed for her refractory osteoporosis?
Produces toxic adenosine triphosphate analog
Inhibits farnesyl pyrophosphate synthase
Vitamin D supplementation
Recombinant N-terminal parathyroid hormone
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Which of the following statements regarding bone mineral density (BMD) is true?
The Z-score is the BMD relative to normal young matched controls
The T-score is the BMD relative to similar aged patients
Osteopenia is defined as a T-score of -1 to -2.5
Osteopenia is defined as a Z-score of -1 to -2.5
Osteoporosis is defined as a Z-score of < -2.5
An 83-year-old woman presents complaining of thigh pain. The pain has been progressing over the last few months. She denies any night chills or recent weight loss. She has smoked 1 pack per day for the last 40 years. Her current medications are alendronate and citalopram. Her current imaging is shown in Figure A. What is the next best step in treatment?
Computed tomography of the chest, abdomen, and pelvis
Standard antegrade femoral nailing
Transfer to an orthopaedic oncologist
Which of the following is accurate regarding sclerostin?
Anti-sclerostin antibodies result in increased bone density
Sclerostin induces osteoblastic differentiation
Sclerostin inhibits osteoblast and osteocyte apoptosis
Sclerostin antagonizes BMP binding to the LRP5/6 receptor
SOST gene mutations have been linked to hereditary osteoporosis
A 55-year-old woman has T-score -2.0 at the femoral neck. According to the World Health Organization Fracture Risk Assessment Tool (FRAX), she has a ten-year probability of sustaining a hip fracture of 1.5% and a ten-year probability of sustaining a major osteoporotic fracture of 8.9%. Which of the following statements is true regarding her antiresorptive therapy management?
Antiresorptive therapy should be started based on her T-score
Antiresorptive therapy should be started based on her risk of hip fracture alone
Antiresorptive therapy should be started based on her risk of major osteoporotic fracture alone
Antiresorptive therapy should not be started
Antiresorptive therapy should be started based on her risks of both hip fracture and major osteoporotic fracture
A 75-year-old woman presents with acute severe back pain after sustaining a mechanical fall while walking out of her yard. She denies pain in her buttocks or legs. On physical exam she has point tenderness over the L1 spinous process. Figure A depicts her current radiograph. Which of the following statements is true regarding here underlying metabolic condition and associated pathology?
Kyphoplasty is indicated within the first week if the pain is severe enough to warrant narcotic medication.
Her underlying metabolic bone condition leads to decreased bone quantity with normal bone quality.
A DEXA T-score of -2.1 in this individual would confirm the diagnosis of osteoporosis according to the WHO.
A 25-hydroxy Vitamin D level of 16ng/mL in this individual would confirm the diagnosis of osteoporosis according to the WHO.
The fracture pattern in Figure A is the third most common fragility fracture in the United States
A 72-year-old woman presents with severe hip pain after stepping off of a curb. She denies any trauma or prior history of hip pain. Her past medical history is reviewed including a list of her current medications. Which of the following of her medications would place her at increased risk for a non-traumatic hip fracture?
Which of the following pharmacologic treatments for osteoporosis has been associated with the potential risk for osteosarcoma development?
Non-nitrogen containing bisphosphonate
Monoclonal Ig2 against RANKL
Nitrogen containing bisphosphonates
Recombinant parathyroid hormone (1-34)
A 55-year-old healthy female presents for a routine physical exam. When discussing bone health and osteoporosis prevention, what dose of calcium and vitamin D should be recommended for daily consumption?
1,500mg of calcium and 1,000 IUs of vitamin D
2,200mg of calcium and 1,000 IUs of vitamin D
750mg of calcium and 5,000 IUs of vitamin D
750mg of calcium and 10,000 IUs of vitamin D
2,200mg of calcium and 5,000 IUs of vitamin D
A 58-year-old woman falls down while walking her dog and sustains the low-energy injury shown in Figures A and B. Which of the following lab values is most likely to be abnormal in this patient?
25-hydroxy cholecalciferol (25 OH vitamin D)
Parathyroid hormone-related protein (PTHrP)
Sry-type high-mobility-group box transcription factor-9 (Sox-9)
LRP5 (low-density lipoprotein receptor-related protein)
A 52-year old woman who is not on any hormone replacement therapy (HRT) falls from standing height and sustains the injury seen in Figure A. Review of her medical history reveals that she carries a diagnosis of osteoporosis, and that her latest T-score was -3.0. How much calcium should she have been consuming on a daily basis prior to sustaining her injury?
A 58-year-old female falls and sustains the injury shown in Figures A and B. Following surgical treatment of the fracture, which of the following is the most appropriate additional investigation?
MRI of the pelvis
CT scan of the pelvis
You are seeing a 13-year-old girl for asymptomatic flat feet and recommend observation. In educating this patient/family about general bone health, you recommend what amount of daily dietary calcium for your patient?
250mg - 500mg
500mg - 750mg
750mg - 1000mg
1000mg - 1500mg
over 1500mg per day
An 80 year-old female undergoes ORIF of her hip fracture without any complications. A hospitalist consult was obtained for medical clearance pre-operatively, and she was diagnosed with osteoporosis. Which of the following treatment scenarios will lead to the best management of the patient's osteoporosis?
Schedule a follow-up appointment with the patients primary care physician to initiate therapy
Order a physical therapy consult and initiate an exercise plan
Have the patient meet with a nutritionist to increase her calcium and vitamin D intake
Start bisphosphonates, and have the patient follow-up with her primary care physician
Perform a metabolic work-up as an inpatient, and set-up an appointment in an osteoporosis clinic
Which of the following administered substances leads to net bone resorption?
Zoledronic acid (Reclast) injection once per year
Teriparatide (Forteo) injection once daily
Alendronate (Fosamax) oral once weekly
Teriparatide (Forteo) continuous infusion for 2 weeks
Alendronate (Fosamax) oral once daily
Which of the following medications is a recombinant form of parathyroid hormone that has been found to stimulate new bone formation in patients with postmenopausal osteoporosis?
Zoledronic acid (Reclast)
According to the 2008 National Osteoporosis Foundation Guidelines for Pharmacologic Treatment of Osteoporosis, when are bisphosphonates indicated for the treatment or prevention of osteoporosis?
DEXA T-score between -1.0 and -2.5
FRAX calculated 10-year hip fracture risk of >3%
FRAX calculated 10-year risk of major osteoporosis-related fracture of >10%
Answers 1 and 2
Answers 1 and 3
Genetic polymorphisms in all of the following genes are associated with osteoporosis EXCEPT?
Vitamin D receptor
Type I collagen alpha-1 chain
Cartilage oligomeric matrix protein (COMP)
Risk factors for insufficiency fractures of the pelvic ring include all of the following EXCEPT:
Total hip replacement with constrained liner
Total hip replacement with ceramic bearings
A 45 year-old woman who has not reached menopause yet falls from a standing height and sustains a distal radius fracture. A DEXA scan reveals a T-score of -2.2. Which of the following treatments is indicated in this patient?
1,700 mg of calcium
1,200 mg of calcium
1,700 mg of vitamin D
1,200 mg of iron
1,700 mg of PTH
With aging, there is a greater loss of mechanical strength in which of the following types of bone?
Cortical bone more than trabecular bone
Trabecular bone more than cortical bone
Cortical bone and trabecular bone equally
Only trabecular bone
Only cortical bone
Which of the following is NOT included in the best management of a elderly female newly diagnosed with a fragility fracture?
Hip and spine densitometry
Laboratory analysis for secondary causes of osteoporosis
Administration of calcium 1,500 mg/day
Administration of Vitamin D 400 to 800 IU/day
Low protein diet
What effect does intermittent administration of parathyroid hormone have on bone?
All of the following medications have been associated with an increased risk of osteoporosis EXCEPT:
Selective serotonin reuptake inhibitors (SSRI)
Non-steroidal anti-inflammatories (NSAIDs)
A 63-year-old woman falls from standing and lands on her right hand. She complains of deformity and wrist pain. Radiographs are provided in Figure A. Following closed reduction, the patient inquires whether she has osteoporosis and if she is likely to have another fracture. In counselling the patient, which of the following is the strongest predictor for a future fracture from low energy trauma?
Bone mineral density T-score < -2.5
Low vitamin D levels
Family history of osteoporosis
History of a prior fragility fracture
Ten year history of oral prednisone use
Regarding bone densitometry, a T-score of -3.5 is defined as which of the following?
Age appropriate bone loss
None. One cannot make this diagnosis without further information.
Which of the following patients are at greatest risk of having a future vertebral fragility fracture?
Elderly female with prior hip fragility fracture
Elderly female with prior distal radius fragility fracture
Elderly female with prior T6 compression fragility fracture
Elderly female with a T-score of -3.0
Elderly female currently on hormone replacement therapy