Osteoporosis - assessment answers

1. Which two statements regarding osteoporosis are correct?
a. Approximately three-quarters of those affected are women
d. Well over 20,000 New Zealanders experience osteoporosis-related fractures each year

2. What roles do primary care play in managing osteopaenia, osteoporosis and fragility fractures?
f. All of the above (screening and evaluation of all patients potentially at risk for low bone density; implementation of lifestyle modifications and falls prevention strategies; assessment of fractures seen in primary care, including determining whether bone fragility is a factor; follow-up and management of patients treated for fragility fractures in secondary care; initiation, continuation and follow-up of anti-osteoporosis treatment)

3. Which two of the following statements concerning dual-energy x-ray absorptiometry are correct?
a. A DXA scan is generally not necessary prior to initiating anti-osteoporosis treatment for those over age 75 with a fragility fracture
b. DXA is the best validated tool for diagnosing osteoporosis and assessing fragility fracture risk

4. When interpreting the results of a DXA scan, which two of the following statements are correct?
b. A T-score of -2.5 or less represents osteoporosis
c. People with a Z-score below -2.0 should be assessed for secondary causes of bone loss regardless of age

5. At what point should patients generally be offered pharmacotherapy to reduce the risk of fragility fracture (three correct answers)?
a. DXA T-score -2.5 or less
c. DXA T-score -1.5 or less with significant risk factors
f. FRAX or Garvan calculator 10-year hip fracture risk >3%

6. Which two statements regarding intravenous zoledronate are correct?
a. A three-day course of oral dexamethasone 4mg daily reduces the acute-phase response associated with zoledronate infusion
c. Switching from oral bisphosphonate therapy to intravenous zoledronate should be considered if the procollagen-1 N-terminal peptide level is above 35μg/L

7. Contraindications for bisphosphonates include which two of the following?
a. Creatinine clearance <35ml/min
d. Significant impairment in oesophageal emptying (eg, oesophageal stricture or achalasia)

8. Bisphosphonates do have adverse effects – which two of the following statements concerning them are correct?
a. Osteonecrosis of the jaw is very rare in the setting of osteoporosis treatment
d. Significant dental issues should ideally be resolved before bisphosphonate treatment

9. Patients established on oral bisphosphonate therapy need which two of the following?
a. P1NP level checked about six months after treatment initiation
d. Consideration of “drug holidays” beyond five years of therapy

10. For fragility fracture patients adhering well to oral bisphosphonate therapy for more than 12 months (P1NP level <35μg/L) and with a T-score -3.0 or less, who then have a second fragility fracture while on treatment, what two other treatment options are available and advisable to consider?
a. Denosumab (funded only for CrCl <35ml/min)
d. Teriparatide

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