Osteoporosis is a silent but serious skeletal disease characterized by low bone mass and microarchitectural deterioration, leading to an increased risk of fracture. Pharmacists play a key role in both the prevention and treatment of this condition, a topic detailed in the Patient Care 5 curriculum. This requires expertise in risk factor assessment, interpretation of diagnostic tools like DEXA scans, and management of complex pharmacotherapies. This quiz will test your knowledge on the pathophysiology, diagnosis, and comprehensive management of osteoporosis, from counseling on bisphosphonates to understanding the use of newer biologic agents.
1. Osteoporosis is a disease characterized by:
- a. Increased bone mineral density.
- b. Low bone mass and microarchitectural deterioration of bone tissue.
- c. Overactive osteoblasts.
- d. A shortened bone remodeling cycle.
Answer: b. Low bone mass and microarchitectural deterioration of bone tissue.
2. Which of the following cells is responsible for bone resorption?
- a. Osteoblasts
- b. Osteocytes
- c. Osteoclasts
- d. Chondrocytes
Answer: c. Osteoclasts
3. According to the World Health Organization (WHO), a T-score of -2.8 on a DEXA scan indicates:
- a. Normal bone density
- b. Osteopenia
- c. Osteoporosis
- d. Severe osteoporosis
Answer: c. Osteoporosis
4. What is the primary mechanism of action of bisphosphonates like alendronate?
- a. They stimulate osteoblasts to build new bone.
- b. They increase intestinal calcium absorption.
- c. They bind to hydroxyapatite in bone and inhibit osteoclast-mediated bone resorption.
- d. They are analogs of parathyroid hormone.
Answer: c. They bind to hydroxyapatite in bone and inhibit osteoclast-mediated bone resorption.
5. A critical counseling point for a patient starting an oral bisphosphonate is to:
- a. Take it with a large meal to prevent GI upset.
- b. Take it at bedtime.
- c. Take it with a full glass of plain water and remain upright for at least 30-60 minutes.
- d. Take it with a glass of milk to increase calcium intake.
Answer: c. Take it with a full glass of plain water and remain upright for at least 30-60 minutes.
6. The “Management of Osteoporosis” is a specific learning module in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. Which medication is the most common cause of drug-induced osteoporosis?
- a. Metformin
- b. Lisinopril
- c. Atorvastatin
- d. Long-term systemic glucocorticoids (e.g., prednisone).
Answer: d. Long-term systemic glucocorticoids (e.g., prednisone).
8. Denosumab (Prolia) is a monoclonal antibody that works by:
- a. Inhibiting sclerostin.
- b. Binding to and inhibiting RANK Ligand (RANKL), which prevents osteoclast formation and activation.
- c. Agonizing the calcium-sensing receptor.
- d. Inhibiting TNF-alpha.
Answer: b. Binding to and inhibiting RANK Ligand (RANKL), which prevents osteoclast formation and activation.
9. Teriparatide and abaloparatide are known as what type of osteoporosis agents?
- a. Antiresorptive agents
- b. Anabolic agents
- c. SERMs
- d. Bisphosphonates
Answer: b. Anabolic agents
10. What is a “drug holiday” in the context of bisphosphonate therapy?
- a. A one-week break from therapy each month.
- b. A temporary discontinuation of the drug after 3-5 years in low-risk patients to reduce the risk of long-term side effects.
- c. Switching from an oral to an IV formulation.
- d. Taking the medication only on weekends.
Answer: b. A temporary discontinuation of the drug after 3-5 years in low-risk patients to reduce the risk of long-term side effects.
11. The Introduction to Osteoporosis is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. A rare but serious adverse effect associated with bisphosphonates and denosumab is:
- a. Hypertension
- b. Osteonecrosis of the jaw (ONJ)
- c. Hypoglycemia
- d. Severe rash
Answer: b. Osteonecrosis of the jaw (ONJ)
13. What is the recommended daily calcium intake for most postmenopausal women?
- a. 500 mg
- b. 800 mg
- c. 1200 mg
- d. 2000 mg
Answer: c. 1200 mg
14. The FRAX tool is used to calculate:
- a. A patient’s T-score.
- b. A patient’s bone mineral density.
- c. A patient’s 10-year probability of major osteoporotic and hip fracture.
- d. The appropriate dose of bisphosphonate.
Answer: c. A patient’s 10-year probability of major osteoporotic and hip fracture.
15. Which of the following is NOT a risk factor for osteoporosis?
- a. Advanced age
- b. Female gender
- c. High body weight (obesity)
- d. Smoking
Answer: c. High body weight (obesity)
16. How is denosumab administered?
- a. As a once-daily oral tablet.
- b. As a once-yearly IV infusion.
- c. As a subcutaneous injection every 6 months.
- d. As a transdermal patch.
Answer: c. As a subcutaneous injection every 6 months.
17. The pharmacology of corticosteroids, a cause of osteoporosis, is covered in the Patient Care 3 curriculum.
- a. True
- b. False
Answer: a. True
18. Which bisphosphonate is administered as a once-yearly intravenous infusion for the treatment of osteoporosis?
- a. Alendronate
- b. Risedronate
- c. Ibandronate
- d. Zoledronic acid
Answer: d. Zoledronic acid
19. Raloxifene is a Selective Estrogen Receptor Modulator (SERM) that has what effect on bone?
- a. It acts as an estrogen agonist in bone, decreasing bone resorption.
- b. It acts as an estrogen antagonist in bone, increasing bone resorption.
- c. It has no effect on bone.
- d. It stimulates both osteoblasts and osteoclasts.
Answer: a. It acts as an estrogen agonist in bone, decreasing bone resorption.
20. An active learning session on osteoporosis is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. Teriparatide is a recombinant form of human:
- a. Calcitonin
- b. Parathyroid hormone (PTH)
- c. Vitamin D
- d. Estrogen
Answer: b. Parathyroid hormone (PTH)
22. Due to concerns about osteosarcoma, the lifetime duration of therapy with anabolic agents like teriparatide is typically limited to:
- a. 6 months
- b. 1 year
- c. 2 years
- d. 5 years
Answer: c. 2 years
23. The pharmacist’s role in osteoporosis management includes:
- a. Identifying patients at risk.
- b. Counseling on lifestyle modifications and fall prevention.
- c. Educating on the proper administration of medications.
- d. All of the above.
Answer: d. All of the above.
24. An active learning session on women’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A patient should be counseled to take their calcium carbonate supplement:
- a. On an empty stomach.
- b. With meals, as it requires an acidic environment for absorption.
- c. At the same time as their iron supplement.
- d. With their bisphosphonate.
Answer: b. With meals, as it requires an acidic environment for absorption.
26. Which of the following is a weight-bearing exercise recommended for patients with osteoporosis?
- a. Swimming
- b. Cycling
- c. Walking or jogging
- d. Stretching
Answer: c. Walking or jogging
27. A T-score compares a patient’s bone density to that of:
- a. An age- and sex-matched individual.
- b. A healthy, young adult of the same sex.
- c. The patient’s own bone density from one year prior.
- d. A patient with a hip fracture.
Answer: b. A healthy, young adult of the same sex.
28. An active learning session on osteoporosis is part of which course module?
- a. Module 3: Women’s Health
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 3: Women’s Health
29. The main reason a patient must remain upright after taking an oral bisphosphonate is to prevent:
- a. Hypotension
- b. Nausea
- c. Esophageal irritation and ulceration
- d. Dizziness
Answer: c. Esophageal irritation and ulceration
30. The management of osteoporosis is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. Romosozumab is a newer agent for osteoporosis with a dual mechanism of action. It works by:
- a. Inhibiting sclerostin, which both increases bone formation and decreases bone resorption.
- b. Inhibiting both RANKL and TNF-alpha.
- c. Acting as both a SERM and a bisphosphonate.
- d. Stimulating both the calcium-sensing receptor and the PTH receptor.
Answer: a. Inhibiting sclerostin, which both increases bone formation and decreases bone resorption.
32. What is the preferred source of Vitamin D?
- a. Vitamin D2 (ergocalciferol)
- b. Vitamin D3 (cholecalciferol)
- c. Calcitriol
- d. Both D2 and D3 are acceptable.
Answer: b. Vitamin D3 (cholecalciferol)
33. The pathophysiology of postmenopausal osteoporosis is primarily due to:
- a. Calcium deficiency
- b. Vitamin D deficiency
- c. Estrogen deficiency, which leads to increased osteoclast activity.
- d. A sedentary lifestyle.
Answer: c. Estrogen deficiency, which leads to increased osteoclast activity.
34. A patient is prescribed ibandronate 150 mg. The pharmacist should counsel the patient to take this medication:
- a. Once daily
- b. Once weekly
- c. Once monthly
- d. Once yearly
Answer: c. Once monthly
35. A key counseling point for a patient starting denosumab is:
- a. The importance of receiving the injection on time every 6 months to avoid a rapid loss of bone density.
- b. That they must take it with food.
- c. That it can be stopped at any time without consequence.
- d. That it is an oral medication.
Answer: a. The importance of receiving the injection on time every 6 months to avoid a rapid loss of bone density.
36. A Z-score compares a patient’s bone density to:
- a. A young adult reference.
- b. An age-, sex-, and ethnicity-matched reference population.
- c. Their own baseline.
- d. A patient with osteoporosis.
Answer: b. An age-, sex-, and ethnicity-matched reference population.
37. Which of the following is NOT a risk factor included in the FRAX tool?
- a. Parental history of hip fracture
- b. Current smoking
- c. Rheumatoid arthritis
- d. Serum Vitamin D level
Answer: d. Serum Vitamin D level
38. The lecture “Introduction to Osteoporosis” is part of the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
39. A patient taking long-term prednisone should be evaluated for osteoporosis and may require prophylactic therapy with:
- a. A bisphosphonate.
- b. Calcium and Vitamin D.
- c. Both a and b.
- d. An anabolic agent.
Answer: c. Both a and b.
40. An active learning session covering osteoporosis is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. Which oral bisphosphonate is also available as an IV injection given every 3 months?
- a. Alendronate
- b. Risedronate
- c. Ibandronate
- d. Zoledronic acid
Answer: c. Ibandronate
42. Raloxifene is effective at reducing the risk of which type of fracture?
- a. Hip fractures only
- b. Vertebral (spinal) fractures only
- c. Non-vertebral fractures only
- d. All types of fractures.
Answer: b. Vertebral (spinal) fractures only
43. A patient must have adequate _____ before initiating a bisphosphonate.
- a. Renal function and serum calcium
- b. Liver function
- c. Thyroid function
- d. Adrenal function
Answer: a. Renal function and serum calcium
44. What is the role of osteoblasts?
- a. To resorb old bone.
- b. To form new bone.
- c. To sense mechanical strain.
- d. To maintain calcium homeostasis.
Answer: b. To form new bone.
45. Which of the following is NOT a medication known to increase fracture risk?
- a. Glucocorticoids
- b. Proton pump inhibitors
- c. Some anticonvulsants
- d. Thiazide diuretics
Answer: d. Thiazide diuretics
46. A patient is considered to have severe osteoporosis if they have a T-score ≤ -2.5 and:
- a. They are over age 65.
- b. They have a history of a fragility fracture.
- c. They have low vitamin D levels.
- d. They are also taking calcium.
Answer: b. They have a history of a fragility fracture.
47. After completing a 2-year course of teriparatide, a patient should be:
- a. Monitored without any further medication.
- b. Switched to an antiresorptive agent like a bisphosphonate to maintain the gains in bone density.
- c. Started on a second anabolic agent.
- d. Discharged from care.
Answer: b. Switched to an antiresorptive agent like a bisphosphonate to maintain the gains in bone density.
48. An active learning session on women’s health is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
49. The overall management of osteoporosis is focused on:
- a. Curing the disease.
- b. Increasing bone density on a DEXA scan.
- c. Preventing fractures.
- d. Reversing all bone loss.
Answer: c. Preventing fractures.
50. The ultimate goal of learning about the management of osteoporosis is to:
- a. Accurately interpret DEXA scans.
- b. Be able to recommend and manage pharmacologic and non-pharmacologic therapies to reduce fracture risk.
- c. Pass the endocrinology exam.
- d. Become an expert on calcium supplements.
Answer: b. Be able to recommend and manage pharmacologic and non-pharmacologic therapies to reduce fracture risk.