Osteoporosis MCQ (August 2012)

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1. Approximately what proportion of women over 50 years will experience an osteoporotic fracture? *
1 in 3
1 in 6
1 in 10
1 in 15

2. Which of the following is the strongest predictor for osteoporotic fracture? *
BMI <22kg/m²
Alcohol intake of 4 or more units per day
Current smoker
Previous fragility fracture

3. Oral bisphosphonates should be swallowed whole with a full glass of water and the patient should remain upright (seated or standing) for at least 30-45 minutes. Why is it important that a patient remains upright after taking bisphosphonates? *
To aid absorption
To minimise the chance of oesophageal ulceration
To reduce the risk of falls
To reduce gastric secretions

4. Oral bisphosphonates should be avoided in which of the following patient groups? *
People under 50 years of age
Patients over 80 years of age
Patients with a T-score less than -3.5
Patients with moderate or severe renal impairment

5. Assuming no other co-morbidities, which of the following patients would be suitable for treatment with alendronic acid for the primary prevention of fragility fracture? *
A 67 year old woman with a BMI of 20kg/m² and no clinical risk factors for fracture
A 62 year old woman with rheumatoid arthritis, a BMI of 26kg/m2 and a T-score of -1.5
A 65 year old woman who drinks 6-7 units of alcohol each day and has a T-score of -2.5
A 76 year old woman with osteoarthritis

6. Which ONE of the following treatments is not recommended for the primary prevention of osteoporotic fracture? *
Alendronic acid
Raloxifene
Strontium ranelate
Denosumab

7. Why should bisphosphonates be used with caution in premenopausal women? *
Because osteoporosis is very uncommon in this patient group
Increased incidence of oesophageal ulceration in younger women
Potential for severe drug interaction with the combined oral contraceptive pill
Because bisphosphonates cross the placenta and teratogenic effects has been seen in animal studies

8. When should strontium ranelate be taken? *
First thing in the morning with a full glass of water
Immediately after the largest meal of the day
At least 2 hours after food, preferably at bedtime
At the same time as the patient’s calcium supplements

9. The monoclonal antibody denosumab is a treatment option for the primary and secondary prevention of osteoporotic fracture. How is this drug administered? *
By subcutaneous injection, every 28 days
By subcutaneous injection, every 6 months
By slow intravenous infusion, every 6 months
By slow intravenous infusion, every 12 months

10. Which ONE of the following is a common side effect of IV zoledronic acid? *
Flu-like symptoms
Dyspepsia
Conjunctivitis
Thirst