Instructions
This self-assessment study guide has 5 questions, each written using learning objectives from your Osteoporosis lecture. Not all learning objectives are covered. Participation/scores are not monitored. FYI this program makes noise sometimes.
Symbols
A lightbulb in the top right corner of a page indicates that the page contains answers or explanations.
Question 1
Read patient case on next page, then press "OK" to begin answering the questions. There are 3 questions and you will have access to the patient information as you answer.
Begin
Q1
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
- Metformin 500 mg BID
- Atorvastatixn 40 mg once daily
- Omeprazole 20 mg BID
Social History
- 1-2 drinks per week
- Doesn't smoke
Past Medical History
- Type 2 diabetes
- Hyperlipidemia
- GERD
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
OK
Q1
Advanced age (>65)
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
- Metformin 500 mg BID
- Atorvastatixn 40 mg once daily
- Omeprazole 20 mg BID
Social History
- 1-2 drinks per week
- Doesn't smoke
PPI (secondary)
Past Medical History
- Type 2 diabetes
- Hyperlipidemia
- GERD
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
T2DM (secondary)
Low body weight (<120 lb)
Click to select risk factors that his patient has that increase her risk for osteoporosis and fractures.
Reveal risk factors
Q1
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
- Metformin 500 mg BID
- Atorvastatixn 40 mg once daily
- Omeprazole 20 mg BID
Social History
- 1-2 drinks per week
- Doesn't smoke
Past Medical History
- Type 2 diabetes
- Hyperlipidemia
- GERD
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
Is osteoporosis screening recommended in this patient?
Q1
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
- Metformin 500 mg BID
- Atorvastatixn 40 mg once daily
- Omeprazole 20 mg BID
Social History
- 1-2 drinks per week
- Doesn't smoke
Past Medical History
- Type 2 diabetes
- Hyperlipidemia
- GERD
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
Given T-scores and FRAX assessment results above, is pharmacologic treatment recommended for this patient?
Q1
Explanation: This patient does not meet diagnostic criteria for osteoporosis and pharmacologic treatment is not recommended.
- The patient does NOT have a history of hip or vertebral fracture
- The patient does NOT have a T-score ≤-2.5 at lumbar spine, femoral neck, total hip, or 1/3 radius
- The patient does have a T-score between -1.0 and -2.5 in spine, femoral nec, and total hip, but she does NOT have high FRAX probabilities (≥3% for hip, ≥20% for major osteoporotic fractures) or a prior fragility fracture
Question 2
Choose the correct options to complete each statement regarding calcium and vitamin D. There are five statements over two pages.
Begin
Q2
Complete the sentences using the terms on the right. Press send to check correctness.
Q2
Choose the correct term to complete each sentence.
Question 3
For each description, choose the medication that best matches from the options on the right.
Begin
Q3
Question 4
For each patient (A-D) on the following page, select the most appropriate thearpy from listed options.
Example:
T-scores
Patient X
hover to see T-scores
Information on risk and fracture history
Information on current osteoporosis medications/medication preferences
Creatinine clearance
Q4
T-scores
Patient A
T-scores
Patient B
Very high risk
- Yearly DXA assessment shows worsening BMD (progression of bone loss)
High risk, no fracture history
Current therapy: alendronate 10 mg once daily
- Experiencing mild heartburn daily
- Fear of injectables
Current therapy: denosumab
- Confirmed adherence to regimen
CrCl: 80 mL/min
CrCl: 90 mL/min
Patient C
Patient D
T-scores
T-scores
High risk, no fracture history
High risk, no fracture history
Current therapy: none
Current therapy: none
- Patient wants PO formulation
- Patient refusees bisphosphonate
CrCl: 75 mL/min
CrCl: 28 mL/min
Q4
T-scores
Patient A
T-scores
Patient B
Very high risk
- Yearly DXA assessment shows worsening BMD (progression of bone loss)
High risk, no fracture history
Current therapy: alendronate 10 mg once daily
- Experiencing mild heartburn daily
- Fear of injectables
Current therapy: denosumab
- Confirmed adherence to regimen
CrCl: 80 mL/min
CrCl: 90 mL/min
Correct answer: abaloparatide 80 mcg daily
- This patient is on an injectable antiresorptive (denosumab) and is failing treatment. If patient is adherent to medications and secondary factors are ruled out, therapy should be escalated from denosumab to an anabolic drug (see algorithm). Abaloparatide is the only anabolic option in the list.
Correct answer: alendrondate 70 mcg weekly
- Common GI adverse effects of bisphosphonates include heartburn and dyspepsia. Switching to less frequent administration is an appropriate management strategy (alendronate daily → alendronate weekly). Switching to an IV bisphosphonate or SQ denosumab would be appropriate strategies as well; however, this patient has a fear of injectable therapy so a switch to less frequent bisphosphonate administration would be reasonable to try first.
Patient C
Patient D
T-scores
T-scores
High risk, no fracture history
High risk, no fracture history
Current therapy: none
Current therapy: none
- Patient wants PO formulation
- Patient refusees bisphosphonate
CrCl: 75 mL/min
CrCl: 28 mL/min
Correct answer: raloxifene 60 mg daily
- Bisphosphonates are ruled out per patient preference; denosumab is ruled out per patient preference since it is not PO. The next choice for a high risk patient would be raloxifene (see algorithm). Raloxifene is only used to reduce risk of vertebral fractures. Looking at T-scores for this patient, BMD is low in spine but not hip, so raloxifene is appropriate.
Correct answer: denosumab 60 mg every 6 months
- Due to this patient’s poor renal function, bisphosphonates should not be used. Denosumab is an option for initial therapy that doesn’t require renal dose adjustments.
Q5
72-year-old male who takes methylprednisolone 12 mg daily for past year for polymyalgia rheumatica
HIGH RISK
Prednisone equivalent = 15 mg15 mg/day x 365 = 5,475 mg/yr
<30 mg daily≥5 g cumulative yearly dose
→→
65 year-old female who takes methylprednisolone 32 mg daily for rheumatoid arthritis for past 6 months
Prednisone equivalent = 40 mg
HIGH RISK
≥30 mg daily
52-year-old female who takes prednisone 5 mg daily following kidney transplant with plan to continue indefinitely
Prednisone equivalent = 5 mg5 mg/day x 365 = 1,825 mg/yr
<30 mg daily<5 g cumulative yearly dose
→→
28-year-old male who takes prednisone 40 mg daily for 7 days for gout flare
Prednisone equivalent = 5 mg
≥30 mg daily - however, duration is <3 months
33-year-old male who has needed steroid burst 4 times in past year - each burst included dexamethasone 4 mg daily for 7 days
Prednisone equivalent = 26.7 mg26.7 mg/day x 7 days/week = 187 mg/week x 4 weeks/year = 748 mg/yr
<30 mg daily<5 g cumulative yearly dose
→→
Osteoporosis - landscape
Madeleine Kochis
Created on October 16, 2025
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Transcript
Instructions
This self-assessment study guide has 5 questions, each written using learning objectives from your Osteoporosis lecture. Not all learning objectives are covered. Participation/scores are not monitored. FYI this program makes noise sometimes.
Symbols
A lightbulb in the top right corner of a page indicates that the page contains answers or explanations.
Question 1
Read patient case on next page, then press "OK" to begin answering the questions. There are 3 questions and you will have access to the patient information as you answer.
Begin
Q1
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
Social History
Past Medical History
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
OK
Q1
Advanced age (>65)
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
Social History
PPI (secondary)
Past Medical History
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
T2DM (secondary)
Low body weight (<120 lb)
Click to select risk factors that his patient has that increase her risk for osteoporosis and fractures.
Reveal risk factors
Q1
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
Social History
Past Medical History
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
Is osteoporosis screening recommended in this patient?
Q1
Patient information: Patient is a 66-year-old postmenopausal female presenting for an annual wellness visit. No fracture history.
Medications
Social History
Past Medical History
Labs/vitals
BP
Height
Weight
CrCl
128/68 mmHg
5'2"
120 lb
65 mL/min
Given T-scores and FRAX assessment results above, is pharmacologic treatment recommended for this patient?
Q1
Explanation: This patient does not meet diagnostic criteria for osteoporosis and pharmacologic treatment is not recommended.
Question 2
Choose the correct options to complete each statement regarding calcium and vitamin D. There are five statements over two pages.
Begin
Q2
Complete the sentences using the terms on the right. Press send to check correctness.
Q2
Choose the correct term to complete each sentence.
Question 3
For each description, choose the medication that best matches from the options on the right.
Begin
Q3
Question 4
For each patient (A-D) on the following page, select the most appropriate thearpy from listed options.
Example:
T-scores
Patient X
hover to see T-scores
Information on risk and fracture history
Information on current osteoporosis medications/medication preferences
Creatinine clearance
Q4
T-scores
Patient A
T-scores
Patient B
Very high risk
High risk, no fracture history
Current therapy: alendronate 10 mg once daily
Current therapy: denosumab
CrCl: 80 mL/min
CrCl: 90 mL/min
Patient C
Patient D
T-scores
T-scores
High risk, no fracture history
High risk, no fracture history
Current therapy: none
Current therapy: none
CrCl: 75 mL/min
CrCl: 28 mL/min
Q4
T-scores
Patient A
T-scores
Patient B
Very high risk
High risk, no fracture history
Current therapy: alendronate 10 mg once daily
Current therapy: denosumab
CrCl: 80 mL/min
CrCl: 90 mL/min
Correct answer: abaloparatide 80 mcg daily
Correct answer: alendrondate 70 mcg weekly
Patient C
Patient D
T-scores
T-scores
High risk, no fracture history
High risk, no fracture history
Current therapy: none
Current therapy: none
CrCl: 75 mL/min
CrCl: 28 mL/min
Correct answer: raloxifene 60 mg daily
Correct answer: denosumab 60 mg every 6 months
Q5
72-year-old male who takes methylprednisolone 12 mg daily for past year for polymyalgia rheumatica
HIGH RISK
Prednisone equivalent = 15 mg15 mg/day x 365 = 5,475 mg/yr
<30 mg daily≥5 g cumulative yearly dose
→→
65 year-old female who takes methylprednisolone 32 mg daily for rheumatoid arthritis for past 6 months
Prednisone equivalent = 40 mg
HIGH RISK
≥30 mg daily
52-year-old female who takes prednisone 5 mg daily following kidney transplant with plan to continue indefinitely
Prednisone equivalent = 5 mg5 mg/day x 365 = 1,825 mg/yr
<30 mg daily<5 g cumulative yearly dose
→→
28-year-old male who takes prednisone 40 mg daily for 7 days for gout flare
Prednisone equivalent = 5 mg
≥30 mg daily - however, duration is <3 months
33-year-old male who has needed steroid burst 4 times in past year - each burst included dexamethasone 4 mg daily for 7 days
Prednisone equivalent = 26.7 mg26.7 mg/day x 7 days/week = 187 mg/week x 4 weeks/year = 748 mg/yr
<30 mg daily<5 g cumulative yearly dose
→→