Osteoporosis: pharmacological prevention and treatment MCQs With Answer

Introduction

Osteoporosis is a major public health concern for M.Pharm students to understand thoroughly—its pharmacological prevention and treatment require knowledge of drug mechanisms, clinical indications, adverse effects, and monitoring. This quiz collection of 20 MCQs is designed to test and deepen your understanding of antiresorptives, anabolics, supplements, and emerging biologics used in osteoporosis management. Questions cover mechanism of action, comparative pharmacology, dosing and administration nuances, safety issues like osteonecrosis of the jaw and atypical fractures, special situations (glucocorticoid-induced osteoporosis, renal impairment), and practical therapeutic decisions. Use these items to sharpen clinical reasoning and exam preparedness for Pharmacotherapeutics I (MPP 102T).

Q1. Which drug class reduces osteoclast-mediated bone resorption primarily by inhibiting farnesyl pyrophosphate synthase in the mevalonate pathway?

• Selective estrogen receptor modulators (SERMs)
• Bisphosphonates
• RANKL inhibitors
• Parathyroid hormone analogs

Correct Answer: Bisphosphonates

Q2. Which agent is a monoclonal antibody that inhibits RANKL and is associated with rapid reversal of antiresorptive effect and increased vertebral fracture risk on abrupt discontinuation?

• Alendronate
• Denosumab
• Raloxifene
• Teriparatide

Correct Answer: Denosumab

Q3. What is the primary anabolic osteoporosis therapy that acts as a recombinant human PTH (1-34) increasing bone formation when given intermittently?

• Calcitonin
• Romosozumab
• Teriparatide
• Zoledronic acid

Correct Answer: Teriparatide

Q4. Which adverse effect is most characteristically associated with long-term bisphosphonate therapy?

• Atypical femoral fractures
• Hypercalcemia
• Uterine bleeding
• Thyroid dysfunction

Correct Answer: Atypical femoral fractures

Q5. For oral bisphosphonates (e.g., alendronate), which administration instruction reduces gastrointestinal adverse effects and improves absorption?

• Take with breakfast and a glass of milk
• Take at bedtime with antacid
• Take on an empty stomach with a full glass of water and remain upright for 30 minutes
• Crush and mix with juice to mask taste

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

Q6. Which therapy is contraindicated in women with a history of venous thromboembolism due to increased clotting risk?

• Raloxifene
• Romosozumab
• Denosumab
• Calcitonin

Correct Answer: Raloxifene

Q7. Romosozumab exerts its dual effect on bone by inhibiting which protein that normally blocks Wnt signaling?

• RANKL
• Sclerostin
• Osteoprotegerin
• Calcitonin gene-related peptide

Correct Answer: Sclerostin

Q8. Which vitamin is essential for active intestinal calcium absorption and is commonly co-prescribed with calcium supplements for osteoporosis prevention?

• Vitamin C
• Vitamin B12
• Vitamin D (cholecalciferol or ergocalciferol)
• Vitamin K

Correct Answer: Vitamin D (cholecalciferol or ergocalciferol)

Q9. Which drug is recommended as first-line parenteral therapy for rapid bone loss or patients intolerant to oral bisphosphonates and is administered once yearly as an IV infusion?

• Risedronate weekly
• Zoledronic acid
• Teriparatide daily
• Calcitonin nasal spray

Correct Answer: Zoledronic acid

Q10. In glucocorticoid-induced osteoporosis, which strategy is preferred to reduce fractures in high-risk patients receiving long-term steroids?

• Short course of calcitonin
• Start bisphosphonate therapy and ensure calcium/vitamin D supplementation
• Initiate estrogen therapy regardless of contraindications
• Rely solely on dietary calcium increase

Correct Answer: Start bisphosphonate therapy and ensure calcium/vitamin D supplementation

Q11. Which monitoring modality is standard for assessing treatment response in osteoporosis by measuring bone mineral density?

• Serum alkaline phosphatase alone
• Dual-energy X-ray absorptiometry (DEXA)
• Quantitative ultrasound of the skull
• Plain radiography of the spine annually

Correct Answer: Dual-energy X-ray absorptiometry (DEXA)

Q12. Which osteoporosis medication has an FDA boxed warning for potential increased risk of myocardial infarction, stroke, and cardiovascular death in certain patients?

• Denosumab
• Romosozumab
• Alendronate
• Calcitonin

Correct Answer: Romosozumab

Q13. Which of the following is the most appropriate management step to reduce vertebral fracture risk after discontinuing denosumab?

• Start romosozumab immediately
• No action is required because effects persist indefinitely
• Transition to a bisphosphonate (e.g., oral or IV) after stopping denosumab
• Give high-dose vitamin C

Correct Answer: Transition to a bisphosphonate (e.g., oral or IV) after stopping denosumab

Q14. Which pharmacologic agent is most appropriate for a postmenopausal woman with severe vertebral fractures and very low BMD who requires anabolic therapy but has a history of osteosarcoma?

• Teriparatide (PTH analog)
• Abaloparatide
• Biphosphonates
• Teriparatide and abaloparatide are contraindicated in history of osteosarcoma

Correct Answer: Teriparatide and abaloparatide are contraindicated in history of osteosarcoma

Q15. Calcitonin is no longer widely recommended for long‑term osteoporosis management primarily because:

• It causes severe hypercalcemia
• It has minimal vertebral fracture risk reduction and potential cancer signal with long-term use
• It is more effective than bisphosphonates, making it first-line
• It cannot be administered intranasally

Correct Answer: It has minimal vertebral fracture risk reduction and potential cancer signal with long-term use

Q16. Which pharmacokinetic consideration is most important when prescribing bisphosphonates in patients with renal impairment?

• Bisphosphonates are hepatically metabolized and safe in renal failure
• IV bisphosphonates have no renal considerations
• Many bisphosphonates are renally cleared and dose adjustments or avoidance are necessary at low creatinine clearance
• Renal impairment prolongs oral bisphosphonate GI absorption

Correct Answer: Many bisphosphonates are renally cleared and dose adjustments or avoidance are necessary at low creatinine clearance

Q17. Which laboratory test should be assessed before initiating antiresorptive therapy to reduce hypocalcemia risk, especially with denosumab or IV bisphosphonates?

• Serum magnesium only
• Serum calcium and 25-hydroxyvitamin D
• Thyroid-stimulating hormone
• Serum phosphate only

Correct Answer: Serum calcium and 25-hydroxyvitamin D

Q18. Atypical femoral fractures associated with bisphosphonates are thought to result from which mechanism?

• Excessive bone turnover and microfracture accumulation due to over-remodeling
• Prolonged suppression of bone remodeling leading to accumulation of microdamage and brittle bone
• Direct toxic effect on osteoblasts causing bone resorption
• Increased RANKL production causing focal osteolysis

Correct Answer: Prolonged suppression of bone remodeling leading to accumulation of microdamage and brittle bone

Q19. Which agent is specifically indicated for osteoporosis in men with hypogonadism when testosterone replacement is contraindicated or insufficient?

• Alendronate
• Teriparatide
• Denosumab
• Both alendronate and denosumab are options; denosumab is specifically approved for men at high fracture risk

Correct Answer: Both alendronate and denosumab are options; denosumab is specifically approved for men at high fracture risk

Q20. Which statement about sequencing osteoporosis therapies to maximize benefit is most accurate?

• Start bisphosphonates then switch to teriparatide for superior long-term gains
• Starting anabolic therapy (teriparatide/romosozumab) before antiresorptives tends to produce larger BMD gains than the reverse sequence
• Antiresorptive therapy must always follow anabolic therapy; the reverse is ineffective
• Sequencing has no impact; only total treatment time matters

Correct Answer: Starting anabolic therapy (teriparatide/romosozumab) before antiresorptives tends to produce larger BMD gains than the reverse sequence

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