1. Robin, a 72-year-old female, has a Z-score of +0.2. What can you determine from this score?
A. She has excellent bone health.
B. She has osteopenia.
C. She has osteoporosis.
D. She has bone health similar to others her age.
E. Unsure
2. Which organization has separate guidelines for osteoporosis in men and women?
A. American Association of Clinical Endocrinologists and American College of Endocrinology
B. American College of Rheumatology
C. The Endocrine Society
D. U.S. Preventive Service Task Force
E. Unsure
3. Betty's primary care provider tells this 70-year-old female that the result of her DXA scan reveals osteoporosis. Which of the following T-scores is classified as osteoporosis?
A. -1.0
B. -1.5
C. -2.2
D. -2.8
E. Unsure
4. Keith, who is 73, lives in Kansas and broke his hip. He has been hospitalized for a week and is being discharged to rehab today. What is the likelihood that he will receive a prescription for osteoporosis drugs at discharge?
A. He will not receive a prescription because these drugs are not started until one year after a fracture.
B. The chances are roughly 1 in 4 that he will receive a prescription for osteoporosis drugs.
C. The chances are roughly 50:50 that he will receive a prescription for osteoporosis drugs.
D. He will receive a prescription for osteoporosis drugs because that is what the guidelines all recommend.
E. Unsure
5. Which of the following has been associated with a decrease in the use of bisphosphonates in patients who should receive guideline-directed care?
A. Widespread media coverage of lawsuits, large jury awards, and television ads for class action suits
B. Lack of clarity about the specific risk factors for osteoporosis in various at-risk populations.
C. Discordance between guidelines creating confusion about when to initiate therapy.
D. Difficult-to-navigate prior authorization processes and the lack of generic equivalents for any effective bisphosphonate.
E. Unsure
6. Which of the following medications is classified as an antiresorptive?
A. Abaloparatide
B. Calcium
C. Ibandronate
D. Romosozumab-aqqg
E. Unsure
7. A postmenopausal woman with osteoporosis has been taking alendronate 10 mg daily for the last 3 years. She came to the pharmacy and said she heard she could stop taking it now and go on a “drug holiday.” She says that she suffers terribly for several hours after each dose. Which of the following is the BEST option?
A. Call the prescriber and ask if she can start a drug holiday since she has been on the medication for 3 years.
B. Use motivational interviewing and at the asking-providing-asking step, suggest alternative options.
C. Explain that drug holidays are not an option with this class of drugs, and she needs to decide to continue or stop.
D. Call the prescriber and tell him that she appears to be a nonresponder to alendronate and ask what to do.
E. Unsure
8. Yvonne is a motivated patient who understands her bone condition well. She in unable to tolerate bisphosphonates (and has tried 3). She has had 3 spontaneous fractures (2 vertebral compression fractures and a hip fracture) in the past 3 years, and her T-score remains at -2.7. While in the hospital for the hip fracture, she developed a pulmonary embolism. Which of the following is her classification based on T-score and a reasonable next step?
A. Osteopenia; increase calcium and vitamin D
B. Osteoporosis; switch to raloxifene
C. Severe osteoporosis; switch to romosozumab
D. Severe osteoporosis; Review lifestyle changes and continue bisphosphonates
E. Unsure
9. Ruby's physician had decided to start her on romosozumab. She has moderate dyspagia. He orders a calcium level and finds that she is hypocalcemic. She also has a history of venous thromboembolism and has taken bisphosphonates. Which of the following is CORRECT?
A. The physician should correct Ruby's hypocalcemia before starting romosozumab.
B. The physician should continue the bisphosphonate for 3 weeks after starting romosozumab.
C. The physician avoid using romosozumab since Ruby has a moderate swallowing disorder.
D. The physician should correct re-evaluate his decision entirely, starting with reordering the calcium level.
E. Unsure
10. Which of the following is a STRONG recommendation from the American College of Physicians?
A. Do not monitor BMD during the 5 years of treatment in women with osteoporosis, as evidence suggests that fracture risk may be reduced regardless of BMD changes.
B. In men with clinically recognized osteoporosis, clinicians should offer bisphosphonate therapy to reduce vertebral fracture risk; evidence is lacking on BMD monitoring in men.
C. In postmenopausal women, do not use estrogen or estrogen plus progestogen or raloxifene for the treatment of osteoporosis.
D. In women with osteoporosis, use pharmacologic treatment for 5 years, employing generic drugs used when possible.
E. Unsure
