Osteoporosis MCQs With Answer

Osteoporosis MCQs With Answer are essential revision tools for B. Pharm students preparing for pharmacology, therapeutics, and clinical pharmacy exams. This concise, informative introduction reviews pathophysiology, bone mineral density assessment, risk factors, and the pharmacology of major drug classes including bisphosphonates, SERMs, denosumab, PTH analogs, and calcitonin. Focused questions reinforce mechanisms of action, dosing, adverse effects, contraindications, drug interactions, and monitoring parameters. Practicing these targeted MCQs enhances clinical reasoning, prescribing safety, and knowledge of prevention strategies such as calcium and vitamin D supplementation and fall risk reduction. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the WHO T-score threshold for diagnosing osteoporosis based on DEXA bone mineral density?

• A T-score ≤ -1.0
• A T-score ≤ -2.5
• A T-score ≤ -3.5
• A T-score ≤ -1.5

Correct Answer: A T-score ≤ -2.5

Q2. Which cell type is primarily responsible for bone resorption in osteoporosis?

• Osteoblasts
• Osteocytes
• Osteoclasts
• Chondrocytes

Correct Answer: Osteoclasts

Q3. Bisphosphonates reduce bone resorption by which primary mechanism?

• Stimulating osteoblast differentiation
• Binding RANKL and preventing osteoclast formation
• Inhibiting farnesyl pyrophosphate synthase in osteoclasts
• Acting as calcium mimetics to increase bone mineralization

Correct Answer: Inhibiting farnesyl pyrophosphate synthase in osteoclasts

Q4. Which bisphosphonate is commonly given as an annual intravenous infusion for osteoporosis?

• Alendronate
• Risedronate
• Zoledronic acid
• Etidronate

Correct Answer: Zoledronic acid

Q5. What important administration counseling point is specific to oral bisphosphonates like alendronate?

• Take with a high-fat meal to increase absorption
• Take on an empty stomach with a full glass of water and remain upright for 30–60 minutes
• Crush tablets and mix with applesauce
• Take at bedtime with milk to reduce gastrointestinal upset

Correct Answer: Take on an empty stomach with a full glass of water and remain upright for 30–60 minutes

Q6. Which adverse effect is specifically associated with long-term bisphosphonate therapy?

• Osteosarcoma in adults
• Atypical femoral fractures
• Severe hypercalcemia
• Pulmonary fibrosis

Correct Answer: Atypical femoral fractures

Q7. Denosumab exerts its effect by targeting which molecule?

• Parathyroid hormone
• Calcitonin receptor
• RANKL
• Vitamin D receptor

Correct Answer: RANKL

Q8. A major administration consideration for denosumab is:

• It must be given orally with food
• It is administered subcutaneously every 6 months
• It is renally cleared and contraindicated in renal impairment
• It requires daily dosing for efficacy

Correct Answer: It is administered subcutaneously every 6 months

Q9. Which anabolic agent stimulates bone formation by activating PTH receptors?

• Denosumab
• Teriparatide
• Raloxifene
• Alendronate

Correct Answer: Teriparatide

Q10. Teriparatide therapy is usually limited to what maximum duration due to safety concerns?

• 6 months
• 1 year
• 2 years
• 5 years

Correct Answer: 2 years

Q11. Raloxifene is classified as what type of drug relevant to osteoporosis?

• Bisphosphonate
• SERM (Selective Estrogen Receptor Modulator)
• Calcimimetic
• Parathyroid hormone analog

Correct Answer: SERM (Selective Estrogen Receptor Modulator)

Q12. Which side effect limits raloxifene use in some patients?

• Hypercalcemia
• Venous thromboembolism
• Severe renal impairment
• Osteonecrosis of the jaw

Correct Answer: Venous thromboembolism

Q13. Which vitamin D form is produced in the skin after UVB exposure and commonly supplemented?

• Calcitriol
• Ergocalciferol (D2)
• Cholecalciferol (D3)
• Calcium carbonate

Correct Answer: Cholecalciferol (D3)

Q14. For monitoring response to osteoporosis therapy, which biochemical marker indicates bone formation?

• C-telopeptide (CTX)
• Procollagen type 1 N-terminal propeptide (P1NP)
• Serum phosphate
• Urinary calcium

Correct Answer: Procollagen type 1 N-terminal propeptide (P1NP)

Q15. Glucocorticoid-induced osteoporosis primarily results from which mechanism?

• Increased vitamin D activation
• Stimulation of osteoblast activity
• Inhibition of osteoblast function and increased bone resorption
• Enhanced calcium absorption from the gut

Correct Answer: Inhibition of osteoblast function and increased bone resorption

Q16. Which medication is first-line therapy for most postmenopausal women with osteoporosis?

• Calcitonin nasal spray
• Oral bisphosphonates (e.g., alendronate)
• Parathyroid hormone analogs
• Estrogen replacement only

Correct Answer: Oral bisphosphonates (e.g., alendronate)

Q17. Osteonecrosis of the jaw is a rare adverse event associated with which osteoporosis treatment?

• Calcium supplements
• Bisphosphonates and denosumab
• Vitamin D supplementation
• Teriparatide

Correct Answer: Bisphosphonates and denosumab

Q18. Which drug increases bone mass by mimicking calcitonin to reduce osteoclast activity?

• Calcitonin
• Alendronate
• Denosumab
• Raloxifene

Correct Answer: Calcitonin

Q19. The FRAX tool is used to estimate which parameter?

• Serum vitamin D level
• 10-year probability of fracture
• Bone turnover marker levels
• Daily calcium requirement

Correct Answer: 10-year probability of fracture

Q20. Which of the following is a modifiable risk factor for osteoporosis?

• Advanced age
• Female sex
• Smoking
• Genetic predisposition

Correct Answer: Smoking

Q21. Which laboratory test is most useful to rule out secondary causes of osteoporosis?

• Serum calcium, phosphate, alkaline phosphatase, TSH, and 25(OH)D
• Fasting insulin only
• Serum uric acid only
• Blood culture

Correct Answer: Serum calcium, phosphate, alkaline phosphatase, TSH, and 25(OH)D

Q22. Which calcium salt provides the highest elemental calcium per tablet?

• Calcium citrate 200 mg
• Calcium carbonate 500 mg
• Calcium gluconate 90 mg
• Calcium lactate 84 mg

Correct Answer: Calcium carbonate 500 mg

Q23. Which patient instruction is important when taking calcium carbonate supplements?

• Take on an empty stomach for best absorption
• Take with meals to enhance absorption
• Avoid taking with vitamin D
• Take simultaneously with bisphosphonates

Correct Answer: Take with meals to enhance absorption

Q24. Which drug reduces vertebral fracture risk but has limited efficacy on hip fractures and may relieve acute vertebral pain?

• Calcitonin
• Risedronate
• Denosumab
• Teriparatide

Correct Answer: Calcitonin

Q25. Which of these is a contraindication to teriparatide therapy?

• History of osteosarcoma or Paget’s disease
• Postmenopausal osteoporosis without prior fractures
• Mild renal impairment
• Concurrent bisphosphonate use

Correct Answer: History of osteosarcoma or Paget’s disease

Q26. Which drug class can cause hypocalcemia as a notable adverse effect, especially in patients with severe renal impairment?

• SERMs
• Denosumab
• Bisphosphonates
• Calcitonin

Correct Answer: Denosumab

Q27. Which clinical scenario most strongly suggests secondary osteoporosis?

• Postmenopausal woman aged 65 with gradual bone loss
• Young man with low BMD and prolonged corticosteroid therapy
• Older man with smoking history only
• Postmenopausal woman with family history of osteoporosis

Correct Answer: Young man with low BMD and prolonged corticosteroid therapy

Q28. Which of the following interactions is important when prescribing oral bisphosphonates?

• Antacids reduce bisphosphonate absorption
• Vitamin D increases bisphosphonate toxicity
• ACE inhibitors potentiate bisphosphonate effect
• Bisphosphonates increase warfarin levels

Correct Answer: Antacids reduce bisphosphonate absorption

Q29. What is the primary reason for recommending a drug holiday after 3–5 years of bisphosphonate therapy in some patients?

• Bisphosphonates become ineffective after 3 years
• To reduce the risk of atypical femoral fractures and osteonecrosis of the jaw
• To allow bone turnover markers to normalize due to toxicity
• To switch to calcitonin for maintenance

Correct Answer: To reduce the risk of atypical femoral fractures and osteonecrosis of the jaw

Q30. Which assessment is most appropriate to monitor efficacy of osteoporosis therapy over 1–2 years?

• Repeat DEXA scan after 1–2 years and bone turnover markers
• Daily serum calcium measurements
• Annual liver function tests only
• Monthly complete blood counts

Correct Answer: Repeat DEXA scan after 1–2 years and bone turnover markers

Q31. Which agent is a monoclonal antibody that can cause rebound bone loss and increased fracture risk if discontinued abruptly without follow-up therapy?

• Alendronate
• Denosumab
• Raloxifene
• Calcitonin

Correct Answer: Denosumab

Q32. In elderly patients, which preventive measure most reduces hip fracture risk?

• High-dose vitamin A supplementation
• Fall prevention strategies and strength/balance exercises
• Strict bed rest
• High-dose iron supplementation

Correct Answer: Fall prevention strategies and strength/balance exercises

Q33. Which drug can be used to treat osteoporosis in men and is also approved for female osteoporosis?

• Alendronate
• Raloxifene only
• Estrogen therapy only
• Calcitonin only

Correct Answer: Alendronate

Q34. Which hormone deficiency is a major contributor to postmenopausal osteoporosis?

• Testosterone
• Estrogen
• Cortisol
• Thyroxine

Correct Answer: Estrogen

Q35. Which of the following is TRUE about oral bisphosphonate renal dosing?

• All oral bisphosphonates are safe in end-stage renal disease without adjustment
• Bisphosphonates are renally excreted and should be used with caution or avoided in severe renal impairment
• Renal function has no impact on bisphosphonate use
• Bisphosphonates directly improve renal function

Correct Answer: Bisphosphonates are renally excreted and should be used with caution or avoided in severe renal impairment

Q36. Which therapeutic approach is most appropriate for a patient with severe osteoporosis and multiple vertebral fractures?

• Lifestyle modification only
• Start an anabolic agent such as teriparatide or abaloparatide
• Stop all osteoporosis medications
• Use topical estrogen only

Correct Answer: Start an anabolic agent such as teriparatide or abaloparatide

Q37. Which medication class can decrease calcium absorption from the gut when given concurrently?

• Proton pump inhibitors (PPIs)
• Loop diuretics
• Statins
• ACE inhibitors

Correct Answer: Proton pump inhibitors (PPIs)

Q38. What is the main clinical indication for measuring 25-hydroxyvitamin D in suspected osteoporosis?

• To diagnose hyperparathyroidism
• To assess vitamin D status for supplementation decisions
• To measure active vitamin D directly
• To monitor renal function

Correct Answer: To assess vitamin D status for supplementation decisions

Q39. Which of the following is a recommended daily elemental calcium intake for most adults over 50 years?

• 200 mg
• 500 mg
• 1000–1200 mg
• 3000 mg

Correct Answer: 1000–1200 mg

Q40. After initiating bisphosphonate therapy, when is the earliest reasonable time to perform a follow-up DEXA scan to assess BMD change?

• Every month
• 6 months
• 1–2 years
• After 10 years

Correct Answer: 1–2 years

Q41. Which adverse effect is more commonly reported with oral bisphosphonates than with intravenous forms?

• Acute phase reaction
• Esophagitis and upper GI irritation
• Renal failure
• Hypocalcemia

Correct Answer: Esophagitis and upper GI irritation

Q42. Which measure can reduce the risk of medication-related osteonecrosis of the jaw in patients starting bisphosphonates?

• Performing invasive dental procedures after starting therapy
• Ensuring good dental hygiene and completing major dental work before therapy
• Avoiding calcium supplements entirely
• Using high-dose corticosteroids concurrently

Correct Answer: Ensuring good dental hygiene and completing major dental work before therapy

Q43. What is the effect of estrogen replacement therapy on bone in postmenopausal women?

• Increases bone resorption
• Decreases bone resorption and prevents bone loss
• Causes rapid bone loss
• Has no effect on bone metabolism

Correct Answer: Decreases bone resorption and prevents bone loss

Q44. Which is TRUE regarding selective estrogen receptor modulators (SERMs) like raloxifene?

• They increase breast cancer risk
• They act as estrogen agonists on bone and antagonists in breast tissue
• They are anabolic agents for bone formation
• They work by inhibiting RANKL directly

Correct Answer: They act as estrogen agonists on bone and antagonists in breast tissue

Q45. Which of the following is a recommended approach when stopping denosumab to prevent rebound bone loss?

• Stop without any follow-up therapy
• Switch to a bisphosphonate to preserve bone density
• Switch to calcitonin only
• Begin high-dose vitamin A

Correct Answer: Switch to a bisphosphonate to preserve bone density

Q46. Abaloparatide is best described as which type of agent?

• RANKL inhibitor
• Parathyroid hormone–related peptide analog with anabolic effects
• Bisphosphonate
• Calcimimetic

Correct Answer: Parathyroid hormone–related peptide analog with anabolic effects

Q47. Which condition is NOT typically a cause of secondary osteoporosis?

• Hyperthyroidism
• Chronic glucocorticoid therapy
• Type 1 diabetes mellitus
• Acute uncomplicated urinary tract infection

Correct Answer: Acute uncomplicated urinary tract infection

Q48. Which antihypertensive drug class may modestly reduce the risk of falls by improving orthostatic tolerance and is sometimes considered in elderly patients with osteoporosis?

• Thiazide diuretics
• Alpha-blockers
• ACE inhibitors
• Loop diuretics

Correct Answer: ACE inhibitors

Q49. Which lifestyle advice is appropriate for patients at risk of osteoporosis?

• Encourage smoking and excessive alcohol use
• Promote weight-bearing exercise, smoking cessation, and moderate alcohol intake
• Recommend complete bed rest to protect bones
• Avoid all sun exposure to prevent skin damage

Correct Answer: Promote weight-bearing exercise, smoking cessation, and moderate alcohol intake

Q50. Which imaging modality is most sensitive for detecting early vertebral fractures and assessing bone quality beyond BMD?

• Plain radiography (X-ray) only
• Quantitative CT (QCT) or high-resolution peripheral quantitative CT (HR-pQCT)
• Ultrasound of the heel
• Electrocardiogram (ECG)

Correct Answer: Quantitative CT (QCT) or high-resolution peripheral quantitative CT (HR-pQCT)

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