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WorksheetsMadras OP LECOM P1
Total questions: 40
Worksheet time: 24mins
What is true about cortical bone?
it is compact bone and make up 80% of bone type
it is cancellous and make up 20% of bone type
forms compact shell around bone
formed in layers and highly calcified
vertebrae, end of long bones, pelvis, wrist, ankle, ribs
What is false about trabecular bone?
also called cancellous and makes up 20% of bones
surface of long and flat bones (forearm, hip)
interior structure
greatest bone turnover
high amount of osteoclast and osteoblast
T/F In bones, proteins provides elasticity and flexibility while minerals provides strength and rigidity
True
False
T/F In young adults, osteoblastic and osteoclastic activity is equal to maintain skeletal bone because there is no remodeling
True
False. Osteoblastic activity is greater than osteoclastic activity
False. Constant remodeling
What is false about osteoblast
promotes mineralization
regulated by calcitriol, estrogen, PTH
release enzyme and metabolic acids
normal aging, there is a progressive decrease in osteoblasts and activity
When RANKL binds to RANK what happens?
fusion of osteoclast precursors into multinucleated cells, differentiation into mature osteoclasts, causes osteoblast to attach to bone surface, osteoblast activate to form bone
fusion of osteoclast precursors into multinucleated cells, differentiate into mature osteoclasts, osteoclast attach to bone surfaces, osteoclast activate to resorb bone, osteoclast apoptosis
fusion of osteoclast precursors into multinucleated cells, differentiate into mature osteoclasts, osteoclast attach to bone surfaces, osteoclast activate to resorb bone, osteoclast survival by preventing apoptosis
T/F Vitamin D2 and D3 are referred to as vitamin D
True
False
What are 3 functions of vitamin D to maintain ca levels
decrease renal reabsorption
increase intestinal absorption of Ca, phosphorous, and magnesium
stimulates bone resorption depending on Ca level in blood
inactivates when there is too much calcium
acts with PTH to maintain free Ca level in blood
What is true about PTH and vitamin D
excess PTH decrease bone resoprtion
PTH and vitaminD promote formation and resorption partially by increasing osteoblast and osteoclast
PTH and vitamin D increase renal Ca retention, but PTH promotes renal phosphate excretion
PTH inhibits renal phosphate excretion
What is osteoporosis?
bone loss= resorption> formation
high bone mass, disruption of bone architecure
increases with age
low BMD increase fracture risk
What is ways to quantify bone loss?
SXA
PIRO
BMX
DEXA
If a patient has a z score of -2.5, does this patient have osteoporosis.
No. A z score is a secondary diagnosis. Needs a t score below -2 for diagnosis with OP
Yes. Z score is a a diagnostic tool
No. Z score below -2 is within normal range
When to order DEXA scan
all women >65 and all men >70
Adults with fragility fractures
before giving pharmacologic therapy for osteoporosis
to monitor osteoporosis treatment
adults taking meds associated with low bone mass
Which statement is true about bone physiology and pathology?
Estrogen is important in women and men to prevent resorption
Bone loss due to aging is predominately from increased osteoclast apoptosis
Osteoprotegerin prevents RANKL from binding to the WNT signalng pathway
Sclerostin inhibits cathepsin K, thereby decreasing bone resorption
FRAX should be used to calculate fracture risk in which patient to determine whether there is a need for therapy
70 year old man currently on denosumab therapy
a postmenopausal woman with a t-score of the lumbar spine of -3
a 58 year old postmenopausal woman with past breast cancer currently on raloxifene
a 66 year old woman with a t score of a total hip of -2
a 70 year old woman with a t score of the spine of -3 and a low trauma vertebral fracture
A patient's T score of DXA are femoral neck (right) -2.2 and lumbar spine -2.8. How would interpret these DXA results?
Normal bone density
Low bone density (osteopenia)
Osteoporosis
A 65-year-old woman is taking osteoporosis prescription medication. She has high blood pressure, hypercholesterolemia, and type 2 diabetes. She has a problem with constipation. After using motivational interviewing, you find she cannot increase her diet to achieve the recommended daily allowances. Her current intake of calcium = 700 mg and vitamin D = 100 units. Which is the best supplement recommendation?
Calcium 250 mg plus 400 units vitamin D combo bid
Calcium citrate 600 mg daily, vitamin D 800 units daily
Calcium carbonate 1200 mg daily, vitamin D 400 units daily
Two multivitamins daily
Which of the following should be completed prior to initiating therapy with denosumab?
Correct any underlying hypocalcemia prior to administration
Educate the patient on the need to remain upright after administration
Inform the patient that the drug cannot be used for more than 2 years
etermine the patient's thromboembolic risk
In which of the following women should bisphosphonate therapy should be recommended? woman with a
T score femoral neck of 0.2
T score femoral neck of -0.9
T score lumbar spine of -1.8, T-score femora neck of -2.1 and 10 year probability of hip fracture of 2%
T-score lumbar spine of −2.2 and 10-year probability of hip fracture of 5%
T-score femoral neck of −2.3 and 10-year probability of major osteoporotic fracture of 15%
T/F SXA (single energy x-ray absorptiometry) measures peripheral sites (like finger, heel) is used in pharmacy and clinics as a diagnostic tool for osteoporosis.
True
False. DEXA is the technic
False. It is not used for diagnosis
T score is the number of SD of an individuals BMD is away from the mean peak BMD for young, health adults of same age, sex, ethnicity
True
False
An 80 year old man has difficult swallowing both food and medications after a stroke. Which agent represents first-line therapy for osteoporosis in this patient?
Subcutaneous teriparatide
Subcutaneous denosumab
Intranasal calcitonin
Effervescent alendronate
Which medication and common adverse effects statement is correct?
Raloxifene—hot flushes, blood clots
Calcitonin—rhinitis, atypical fractures
Denosumab—increased cholesterol, serious infections
Alendronate—nausea, osteonecrosis of the jaw
Bazedoxifene and conjugated equine estrogens—blood clots, atypical fractures
Mr. Jones, a 60-year-old man who just started treatment for prostate cancer, wants to know why his doctor wants to start an osteoporosis medication. Your best answer is?
Cancer and some chemotherapy agents cause bone loss and fractures that can be prevented with these medications.
. Because of your age, he prescribed it to prevent age-induced osteoporosis.
This medication will prevent high serum calcium and other bone related problems associated with your cancer.
The osteoporosis medication is not needed.
You identify a 75-year-old woman who has not refilled her alendronate prescription for the last 3 months. She tells you she is concerned about osteonecrosis of the jaw (ONJ). Your response is?
There is no risk of ONJ with oral osteoporosis medications.
ONJ only happens in patients with cancer.
Due to the risk of ONJ, you call her doctor to get it switched to raloxifene.
ONJ is very rare and she should continue alendronate since she is more likely to have a hip fracture.
What are the goals of prevention for osteoporosis
Enhance development of skeleton and maximize peak bone mass
Prevent falls and fractures
maintain BDM and prevent age-related bone loss
Damage skeleton integrity
Which is not part of the very high risk category for OP?
Recent fracture (within previous 12 months)
very low t-score (<-3.0)
high risk for falls
very high fracture probability by FRAX (eg major osteoporosis fracture >30%, hip fracture >4.5%) or other validated fracture risk algorithm
Few Fractures when taking medication that effect skeleton
What are the benefits of exercise?
stimulates osteoblasts
long term during youth has increase peak BMD
swimming and cycling are good choices
Decrease falls improve balance
Which drug does not decrease bone resorption by inhibiting osteoclast activity
PTH
Calcium
Bisphosphonates
Raloxifene
Denosumab
which are anabolic agents
alendronate
teriparatide
abaloparatide
estrogen
calcitonin
Which Bisphosphonates are IV
Ibandronate
Zoledronic acid
Etidronate
Pamidronate
Alendronate
Counterindications for bisphosphonates include
food adversion
Hypocalcemia
severe renal impairment
esophagus abnormalities
What is false about calcitonin
nasal formulation is used
top therapy for women with OP who are at least 5 years postmenopausal
calcitonin inhibits PTH
analgesic effects
may increase cancer risk
T/F Conjugated estrogen combined with medroxyprogesterone acetate increase risk of MI, stroke, breast cancer, pulmonary embolism, DVT
T
F
T/F Estrogen but not HRT is only used if the benefits outweigh the risks and should be used in he shortest duration consistent with treatment goals and risk for the individual woman.
True
False. Estrogen and HRT
False. HRT but not estrogen
False. Both don't carry those risk
What are the two big concerns when taking Raloxifene
hot flashes
venous thromboembolism
stroke
Liver disease
T/F Combination of conjugated estrogens with estrogen agonist/ antagonist indicated for prevention of postmenopausal osteoporosis in women without a uterus
T
F
What is false about teriparatide?
box warning for osteosarcoma
treatment effects may be monitored by DXA after 18 months
subq in abdomen or thigh
can be taken indefinitely
Which drugs are taken by SQ?
Denosumab (Prolia)
Abaloparatide (Tymlos)
Teriparatide (Forteo®)
Romosozumab (Evenity)
Which disease and definition are correct
Osteomalacia: soft bones
Paget's Disease : chronic, slowly progressive skeletal condition of abnormally rapid bone destruction (osteolytic) and reformation (osteoblastic).
Osteomalacia: characterized by osteoclastic resorption of bone with new bone laid down in a disorganized fashion
Paget's Disease: inadequate or delayed mineralization of bone
