Chapter 69 Osteoporosis
Clinical Case Problem 1: A 61-Year-Old Postmenopausal Woman
Select the best answer to the following questions
1. You believe she is at risk for osteoporosis. You initially recommend that she
2. The test of choice in the diagnosis of osteoporosis is
3. Which of the following is not an established major risk factor for osteoporosis?
4. According to the National Osteoporosis Foundation (NOF), in which case would primary screening for osteoporosis be appropriate?
5. According to the World Health Organization (WHO), osteoporosis is defined as
6. Which of the following is not an associated risk factor for osteoporosis?
7. What is the most common presenting fracture in osteoporosis?
8. Which of the following sites for osteoporotic fracture is most commonly associated with morbidity and mortality?
9. Which of the following conditions is not associated with an increased risk for osteoporosis?
10. You order a central DXA scan for the patient in Clinical Case Problem 1. The scan returns with a T score of −1.3 for the lumbar spine and a T score of −1.9 for the total hip. What do you recommend to the patient at this time?
11. Which of the following is not a therapy approved by the Food and Drug Administration (FDA) for the prevention of osteoporosis?
12. Which of the following statements regarding nonpharmacologic management for the prevention and treatment of postmenopausal osteoporosis is (are) true?
13. Which of the following statements about calcium supplementation is true?
14. Which of the following is not recommended for treatment of established osteoporosis?
15. Which of the following studies may be indicated in an asymptomatic patient recently diagnosed with osteoporosis?
16. Your patient from Clinical Case Problem 1 returns after taking a bisphosphonate for 6 months for confirmed osteoporosis. Her initial laboratory results are normal, including CBC, serum chemistry profile, and 25-hydroxyvitamin D level. A baseline serum N-telopeptide level was determined before the initiation of bisphosphonate therapy and found to be elevated. The patient has followed your recommendations about weight-bearing exercise and calcium intake. She wants to know if the “treatments have worked.” You tell her the following test may assess effectiveness of treatment at this time:
Answers
1. a.Central DXA is the gold standard for assessment of BMD. During this procedure, two beams of different energy are directed at the patient. The difference in the absorption rate of the two energy beams by the patient’s body is recorded to quantify the amount of bone mineral content. A BMD is computed at different sites, including the lumbar spine (L1-4), femoral neck, and total proximal femur (hip); Ward triangle is a computer-generated area and should not be used for diagnosis. At least two different sites, preferably the spine and hip, should be measured. Of all measurements, total hip BMD is the best predictor of future hip fracture.
2. c.As discussed previously, central DXA is the gold standard for assessment of BMD. QCT was discussed previously as well. Peripheral bone densitometry devices use a variety of techniques, including radiographic absorptiometry and pDXA. Peripheral QUS is yet another method of assessing BMD. Measurement sites include the finger, forearm, and heel. Advantages of these modalities include less expense, easier portability, and relatively low to no radiation exposure. Peripheral devices can be useful for assessment of fracture risk and identification of patients unlikely to have osteoporosis. However, peripheral BMD devices lack the precision of central DXA and thus should not be used for diagnosis of osteoporosis or osteopenia or for monitoring of patients.
3. d.Of the major risk factors for postmenopausal osteoporosis, age older than 65 years is most consistently associated with increased risk of osteoporosis. Compared with women aged 50 to 54 years, there is a 5.9-fold higher risk of osteoporosis in women aged 65 to 69 years and a 14.3-fold higher risk in women aged 75 to 79 years. In addition to age, gender, and menopausal status, the NOF lists the following major risk factors for postmenopausal osteoporosis and related fracture:
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