CME questions: review of treatment modalities for postmenopausal osteoporosis.1. Which of the following statements about osteoporosis osteoporosis (ŏs'tēō'pərō`sĭs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia is NOT true?a. More than 1.5 million osteoporotic fractures Fractures Definition A fracture is a complete or incomplete break in a bone resulting from the application of excessive force. Description occur in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. each year. b. Twenty percent of women with a prevalent vertebral ver·te·bral adj. 1. Of, relating to, or of the nature of a vertebra. 2. Having or consisting of vertebrae. 3. Having a spinal column. fracture will fracture again within a year. c. Osteoporotic fractures are associated with significant morbidity morbidity /mor·bid·i·ty/ (mor-bid´it-e) 1. a diseased condition or state. 2. the incidence or prevalence of a disease or of all diseases in a population. mor·bid·i·ty n. and excess healthcare costs. d. The incidence of osteoporosis will decrease by the year 2010. e. Women with prior fractures are at particularly high risk of sustaining a fragility fracture In traumatology, a fragility fracture is a bone fracture that occurs as a result of a fall from standing height or less. There are three fracture sites said to be typical of fragility fractures: vertebral fractures, fractures of the neck of the femur and Colles fracture of the . 2. Adequate daily intake of calcium for adults is a. 100-200 mg b. 200-400 mg c. 400-700 mg d. 700-900 mg e. 1000-1200 mg 3. Which of the following is NOT a particularly good source of dietary calcium? a. Milk b. Cheese c. Soy beans d. Spinach e. All of the above are good sources of calcium 4. Good sources of vitamin D vitamin D Any of a group of fat-soluble alcohols important in calcium metabolism in animals to form strong bones and teeth and prevent rickets and osteoporosis. It is formed by ultraviolet radiation (sunlight) of sterols (see steroid) present in the skin. include all of the following EXCEPT a. Fish and egg yolks b. Fortified fortified (fôrt  ´fīd),adj containing additives more potent than the principal ingredient. milk c. Exposure to sunlight d. Fruit e. Liver 5. Which of the following is TRUE regarding calcium and/or vitamin D therapy for fracture prevention? a. A number of large studies have demonstrated fracture risk reduction with vitamin D in patients with prevalent fragility fractures. b. Meta-analyses have generally shown a beneficial effect of calcium/vitamin D on vertebral fracture risk. c. Calcium/vitamin D supplementation is typically not administered to patients in clinical trials of osteoporosis drugs. d. The RECORD study confirmed fracture risk reduction with calcium and vitamin D treatment for secondary prevention of fractures. e. In general, calcium and vitamin D supplementation are not well tolerated by patients. 6. Which of the following is approved for both prevention and treatment of postmenopausal post·men·o·paus·al adj. Of or occurring in the time following menopause. postmenopausal Change of life Gynecology adjective Referring to the time in ♀ when menstrual periods stop for ≥ 1 yr osteoporosis? a. Alendronate alendronate /alen·dro·nate/ (ah-len´dro-nat) a bisphosphonate calcium-regulating agent used in the form of the sodium salt to inhibit the resorption of bone in the treatment of osteitis deformans, osteoporosis, and hypercalcemia related b. Ibandronate c. Risedronate d. Calcitonin calcitonin /cal·ci·to·nin/ (-to´nin) a polypeptide hormone secreted by C cells of the thyroid gland, and sometimes of the thymus and parathyroids, which lowers calcium and phosphate concentration in plasma and inhibits bone resorption. e. A, B, and C 7. Which of the following is FALSE regarding the effect of alendronate treatment on bone mineral density bone mineral density n. See bone density. bone mineral density A measurement of bone mass, expressed as the amount of mineral–in grams divided by the area scanned in cm2. See Bone densitometry. (BMD BMD In currencies, this is the abbreviation for the Bermudian Dollar. Notes: The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. )? a. Alendronate is associated with greater increases in BMD than estrogen or raloxifene. b. Alendronate 70 mg weekly produces markedly greater increases in spine BMD than alendronate 10 mg/d. c. Alendronate is associated with greater increases in BMD than salmon calcitonin. d. Larger increases in spine BMD do not necessarily translate into larger reductions in vertebral fracture risk. e. Alendronate is associated with smaller increases in BMD than teriparatide. 8. Which of the following is FALSE regarding the alendronate Fracture Intervention Trial (FIT) results? a. Vertebral fracture risk was reduced after 3 and 4 years in FIT1 and FIT2. b. Overall nonvertebral fracture risk was significantly reduced in both FIT1 and FIT2. c. Hip fracture hip fracture Orthopedic surgery A femoral fracture which affects 1/6 white ♀–US during life Epidemiology 250,000/yr–US Specifics Proximal femur; 90+% femoral neck, intertrochanteric; 5-10% are subtrochanteric Risk factors Tall, thin ♀, risk was significantly reduced in FIT1. d. FIT1 patients had prevalent vertebral fractures at base-line. e. Prospective 1-year vertebral fracture data are not available from FIT1 or FIT2. 9. Post hoc post hoc adv. & adj. In or of the form of an argument in which one event is asserted to be the cause of a later event simply by virtue of having happened earlier: analyses of combined FIT1/FIT2 data showed all but which of the following statements? a. The incidence of upper gastrointestinal adverse events was similar in alendronate and placebo recipients. b. Overall nonvertebral fracture risk was significantly reduced in women with confirmed osteoporosis. c. One-year clinical vertebral fracture risk was significantly reduced in patients with 1 prevalent vertebral fracture and low BMD. d. Hip fracture risk was significantly reduced after 6 months. e. Three-year hip fracture risk was significantly reduced in patients with confirmed osteoporosis. 10. Which is the following is FALSE regarding ibandronate? a. Both the 2.5 daily and 150 mg monthly doses are approved for use in the United States. b. The oral ibandronate osteoporosis vertebral fracture trial in North America North America, third largest continent (1990 est. pop. 365,000,000), c.9,400,000 sq mi (24,346,000 sq km), the northern of the two continents of the Western Hemisphere. and Europe (BONE) study showed a significant reduction in 3-year vertebral fracture risk with ibandronate 2.5 mg/d. c. The BONE study reported a significant reduction in 3-year nonvertebral fracture risk. d. Once-monthly ibandronate 150 mg produces similar improvements in hip and spine BMD as once-daily ibandronate 2.5 mg. e. Vertebral fracture risk was significantly reduced after 2 years of treatment with ibandronate 2.5 mg/d. 11. Which of the following statements is TRUE concerning the Vertebral Efficacy With Risedronate Therapy (VERT) studies? a. One-year morphometric vertebral fracture risk was significantly reduced by over 60% in both studies. b. VERT study patients had at least one prevalent vertebral fracture at baseline. c. Nonvertebral fracture risk was significantly reduced after 3 years in one of the VERT studies. d. Hip fracture risk was a primary outcome measure in the VERT studies. e. A, B, and C are true. 12. Which of the following statements of FALSE concerning the risedronate Hip Intervention Program (HIP) study? a. The HIP study is one of many studies that had hip fracture as a primary end point. b. Group 2 patients were recruited mostly on the basis of nonskeletal risk factors, and therefore, many patients did not have confirmed osteoporosis. c. Three-year hip fracture risk was not significantly reduced in group 2 patients. d. Three-year hip fracture risk was significantly reduced in group 1 patients (ie, those with confirmed osteoporosis). e. Three-year hip fracture risk was significantly reduced in combined group 1 and group 2 patients. 13. Which of the following is TRUE concerning trials of bisphosphonate therapy? a. Alendronate, risedronate, and ibandronate trials excluded patients with a history of upper gastrointestinal disease gastrointestinal disease, n an abnormal state or function of the GI system. . b. All trials demonstrated significant reductions in hip fracture risk. c. Vertebral fracture risk was significantly reduced by 20% to 30% after 3 years of treatment. d. All trials demonstrated significant reduction in overall nonvertebral fracture risk. e. Most patients had confirmed osteoporosis and/or prevalent vertebral fracture. 14. Which of the following statements is FALSE concerning the Multiple Outcomes of Raloxifene study? a. There were 2 subgroups, 1 with prevalent vertebral fracture and 1 without. b. Three-year vertebral fracture risk was significantly reduced by 30% in women with prevalent vertebral fracture. c. Three-year vertebral fracture risk was significantly reduced by 50% in women without prevalent vertebral fracture. d. Four-year nonvertebral fracture risk was significantly reduced by raloxifene therapy. e. Hot flashes hot flashes Hot flush Gynecology A symptom afflicting 80-85% of middle-aged ♀, first occurring during the perimenopause, continuing with ↓ intensity for yrs, manifesting itself as transient waves of erythema and uncomfortable warmth beginning in the were reported in significantly more raloxifene than placebo recipients. 15. Which of the following statements about salmon calcitonin nasal spray Nasal sprays are used for the nasal delivery of a drug or drugs, generally to alleviate cold or allergy symptoms such as nasal congestion. Although delivery methods vary, most nasal sprays function by instilling a fine mist into the nostril by action of a hand-operated pump in the Prevent Recurrence recurrence /re·cur·rence/ (-ker´ens) the return of symptoms after a remission.recur´rent re·cur·rence n. 1. of Osteoporotic Fractures study is correct? a. Morphometric vertebral fracture risk was dose-dependently reduced by salmon calcitonin. b. Salmon calcitonin 200 IU/d significantly reduced vertebral fracture risk by 33% after 5 years. c. Nonvertebral fracture risk was dose-dependently reduced by salmon calcitonin. d. The study was not sufficiently powered to provide a meaningful analysis of nonvertebral fracture risk. e. B and D. 16. Which of the following statements concerning teriparatide is FALSE? a. Teriparatide is an antiresorptive drug with a similar mechanism of action to bisphosphonates. b. Teriparatide is approved for long-term (> 4 yr) osteoporosis treatment. c. Teriparatide has demonstrated significant reductions in vertebral and nonvertebral fracture risk. d. A and B. e. B and C. 17. Based on available data, which of the following is probably the best approach to administering teriparatide and antiresorptive therapy? a. Teriparatide concurrently with alendronate b. Alendronate alternating with teriparatide every 2 months c. Teriparatide followed by antiresorptive therapy to maintain BMD gains achieved with teriparatide d. A and B e. B and C 18. Which of the following drugs both increases bone formation and deceases bone resorption Bone resorption is the process by which osteoclasts break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood. The osteoclasts are multi-nucleated cells that contain numerous mitochondria and lysosomes. ? a. Teriparatide b. Zoledronic acid zoledronic acid /zo·le·dron·ic ac·id/ (zo´le-dron?ik) a bisphosphonate inhibitor of osteoclastic bone resorption, used for the treatment of hypercalcemia of malignancy. c. Strontium strontium (strŏn`shēəm) [from Strontian, a Scottish town], a metallic chemical element; symbol Sr; at. no. 38; at. wt. 87.62; m.p. 769°C;; b.p. 1,384°C;; sp. gr. 2.6 at 20°C;; valence +2. d. Raloxifene e. Salmon calcitonin 19. Which of the following is not an approved oral bisphosphonate administration schedule? a. Alendronate 10 mg/d b. Risedronate 5 mg/d c. Ibandronate 2.5 mg/d d. Zoledronic acid 8 mg/d e. Risedronate 35 mg/wk 20. Which of the following statements is FALSE concerning osteoporosis therapy? a. Antiresorptive drugs reduce fracture risk out of proportion to their relatively small improvements in BMD. b. Most organizations recommend against using estrogen for the sole purpose of osteoporosis prevention. c. All patients should receive adequate calcium and vitamin D intake. d. Teriparatide significantly reduces vertebral and nonvertebral fracture risk. e. Raloxifene and salmon calcitonin reduce hip fracture risk. Answers to CME CME See: Chicago Mercantile Exchange CME See Chicago Mercantile Exchange (CME). Questions 1. D, 2. E, 3. E, 4. D, 5. B, 6. E, 7. B, 8. B, 9. D, 10. C 11. E, 12. A, 13. E, 14. D, 15. E, 16. D, 17. C, 18. C, 19. D, 20. E On the whole human beings want to be good, but not too good and not quite all the time. --George Orwell |
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