1. Why do patients with osteoporosis have a high risk for a second fracture?
a. immobility leads to increased bone resorption
b. immobility leads to decreased bone resorption
2. The efficacy of drugs for preventing osteoporosis depends on what?
a. availability and gut absorption rate
b. adequate intake of vitamin D and calcium
3. How do ostocytes develop?
a. hematopoietic stem cell –> pre-clast –> clast –> cytes
b. hematopoietic stem cell –> pre-blast –> blast –> cytes
4. How do osteoblasts develop?
a. hematopoietic stem cell –> pre-blast –> blast
b. mesenchymal stem cell –> pre-blast –> blast
5. Why do bisphosphonates accumulate in osteoclasts?
a. inhibit resorption and require resorption to be released from bone = prolonged residence time in bone
b. they do not accumulate. accumulation would cause remodeling of bone
6. what are side effects of bisphosphonates?
a. calcium deficiency, leukopenia
b. esophagitis, esophageal ulcers
7. How does estrogen affect bone?
a. balances resorption and formation
b. controls levels of vitamin D and calcium metabolism
8. What happens to bone with estrogen deficiency?
a. Less reabsorption
a. excess resorption
9. What governs the rate of pre-osteoclasts to osteoclasts?
b. estrogen and progesterone
10. The body can only absorb about ____-____ mg of Ca at a time
11. T or F? The MOA of SERMs?
MOA: estrogen agonist in bone – suppresses proliferation and differentiation of osteoclasts, and increases their apoptosis also estrogen agonist in CV system and antagonist on breast and uterus tissue
12. T or F? Calcitonin balances the effects of _____
13. What is the active form of Vitamin D?
a. 1a,25-dihydroxyvitamin D (calcitriol)
b. 1a,20-dihydroxyvitamin D (calcitriol)
14. T or F? What is roloxifene?
An antiresoptive agent which is an estrogen agonist in the bone and antagonist elswhere
15. Bisphosphonates are contra-indicated in which patients?
a. Those w/ pre-existing hypocalcemia
b. Those under 30
16. T or F? Calcitonin
Inhibits osteoclasts – modest effects – dec pain w/ acute vertebral compression fracture
17. In normal bone metabolism, what happens when blood Ca levels are high?
a. Calcitonin inhibits bone resorption by osteoblasts to prevent any excess Ca release
b. Calcitonin inhibits bone resorption by osteoclasts to prevent any excess Ca release
18. PTH is released from chief cells of parathyroid in response to _____
a. low serum calcium concentration
b. high serum calcium concentration
19. Treatment decisions for osteoporosis should not be based solely on BMD. Which of the following should also be considered?
a. Previous osteoporotic fractures
b. Serum vitamin D levels
c. Thyroid function testing
d. Cost, compliance and safety of proposed treatment
e. All of the above
20. Vitamin D analogues (Calcijex, calcitriol, doxercalciferol, Hectorol, paricalcitol, Rocaltrol
Zemplar) have been shown to cause hypercalcemia and are not therefore recommended for the routine treatment of osteoporosis in the USA. T or F?
21. Which of the following statements regarding the bisphosphonates is NOT true?
a. Monthly dosing as opposed to daily dosing reduces the risk of oesophagitis
b. Safety in pregnancy has not been established
c. Bisphosphonates work by inhibiting osteoclast attachment and enhancing programmed cell death
d. Bisphosphonates are not considered first-line therapy in severe osteoporosis (they ARE)
e. Discontinuation of alendronate after 5 years results in minimal bone loss over the ensuing 5 years.
22. It is wise to recommend a full dental assessment and completion of any required procedures before initiating therapy with bisphosphonates. T or F? (can cause necrosis of jaw)
23. Thyroid hormone increases the rate of bone turnover. In hyperthyroidism osteoblasts cannot form bone as quickly as osteoclasts resorb bone. Hyperthyroidism can therefore lead to osteoporosis. T or F?
24. Osteoporosis is a disorder of:
a. Decreased bone mass
b. Increased estrogen level
c. Autoimmune disorder
d. All of he above
25. Postmenopausal women are more prone to suffer from osteoporosis due to:
a. Decreased progesterone level
b. Increased progesterone level
c. decreased estrogen level
d. Increased estrogen level
26. Which tool is known as the ‘Gold Standard’ for diagnosing osteoporosis?
a. Biochemical markers of bone
c. Ultrasound of heal
d. DEXA Dual energy x-ray absorbtiometry
27. Alendronate can be used on which type of osteoporosis?
a. Postmenopausal osteoporosis
b. Male osteoporosis
c. Steroid induced osteoporosis
d. all of the above
28. Alendronate is used in treatment of osteoporosis because it:
a. Inhibits osteoclastic activity
b. Inhibits osteoblastic activity
c. Increases calcium absorption
d. Activates PTH
29. Which is not an antiresorptive drug
b. Vitamin D
30. A 24-year-old man on chronic corticosteroid therapy for severe asthma presents with a 6-month history of increasing hip pain. This patient most likely exhibits symptoms of which of the following metabolic bone diseases?
a. Gaucher disease
b. Osteomalacia (softening of the bones caused by defective bone mineralization secondary to inadequate levels of available phosphate and calcium, or because of overactive resorption of calcium from the bone
c. Osteopetrosis (bone disease that makes bones abnormally dense and prone to breakage (fracture)
e. Paget disease
The answer is D: Osteoporosis. Risk factors for osteoporosis include smoking, vitamin D defi ciency, low body mass index, hypogonadism, a sedentary lifestyle, and glucocorticoid therapy (seen in this patient). Bone loss and fractures are the hallmarks of osteoporosis, regardless of the underlying cause. Choices A and C are congenital disorders that are not related to corticosteroid therapy. Choices B and E are acquired conditions but they are not related to corticosteroid therapy. Diagnosis: Osteoporosis
31. A 58-year-old woman fractures her hip after slipping on an icy sidewalk. An X-ray shows generalized osteopenia. A bone biopsy reveals attenuated bony trabeculae and a normal ratio of mineral-to-matrix. Serum calcium and phosphorus levels are normal. Which of the following best explains the pathogenesis of osteopenia in this postmenopausal woman?
a. Impaired mineralization of osteoid
b. Increased osteoblast activity
c. Increased mineralization of bone
d. Increased osteoclast activity
e. Mosaic bone formation
Type 1 osteoporosis – increase in osteoclast activity
Type 2 osteoprosis – decresed osteoblast activity
32. What is the most frequent secondary cause of osteoporosis in adults?
2. Hypogonadism (anorexia. amenorrhea, etc)
33. T or F: Patients with RA may present with low bone mass. (not related to Tx of steriods etc)
34. T or F. Chronic alcohol ingestion is detrimental to the skeleton. (it suppresses osteoblast function and enhances bone resorption, they will also have low vitamin D levels)
35. In addition to glucocorticoids, what other drug can put a person for risk of developing osteoporosis?
a. Anticonvulsants (dilantin etc)
b. chronic heparin therapy
c. antpsychotic drugs
d. second generation SSRIs
e. proton pump inhibitors (low magnesium)
h. cyclosporin-tacrolimus (immunosuppressants)
h. all of the above
i. none of the above