Post-test for managing postmenopausal osteoporosis in general practice

Now that you have worked through the interactive case history, please have another go at taking the test that you took earlier. This time you will get feedback on your answers.


Please choose one correct answer for each question:

1. Osteoporosis is a progressive skeletal disease:

a. Characterised by loss of calcium

b. Characterised by excess parathyroid hormone

c. Characterised by loss of bone mass

d. Characterised by defective mineralisation of bone

e. In which localised areas of bone become hyperactive and are replaced by a softened osseous material

2. The diagnosis of osteoporosis is based on assessing bone mineral density using dual energy x ray absorptiometry. Which of the following statements concerning bone mineral density is correct?

a. A bone mineral density that is 1.5 standard deviations or more below the age-matched mean indicates osteoporosis (Z score <-1.5)

b. A bone mineral density that is 2.5 standard deviations or more below the age-matched mean (Z score <-2.5) does not always indicate osteoporosis

c. A bone mineral density that is 2.5 standard deviations or more below the average value for premenopausal women (T score <-2.5) indicates osteoporosis

d. A T score between -1 and -2.5 indicates osteoporosis

e. Absolute values of bone mineral density that indicate osteoporosis are different for men and for women

3. A 70 year old woman comes to your surgery. She has recently fallen and fractured her wrist. She is concerned that she may fall again and fracture her hip. When advising her, which of the following statements is true?

a. Women have the same risk of fracturing their hip as do men of the same age

b. The lifetime risk of a hip fracture from age 50 years onwards has been estimated at 10% for white women

c. Adults who sustain one fracture are 50-100% more likely to have another at a different site

d. The increase in fractures with age is totally explained by the decrease in bone mineral density

e. Rates of hip fracture are the same in urban populations as in rural populations of the same country

4. A 52 year old woman comes to see you. She had her menopause at age 50. She is concerned about the possibility of fractures from osteoporosis and asks whether you can predict her risk. Which one of the following is not predictive of osteoporotic fracture?

a. A history of maternal hip fracture

b. Increase in weight since age 25

c. Current use of long-acting benzodiazepines

d. High caffeine intake

e. Cigarette smoking

5. You want to set up a screening programme for postmenopausal osteoporosis in your practice and decide to begin with women at greatest risk. Using the data given below, which of the following combinations of risk factors would give the highest 10-year probability of fracture risk (assuming that these risk factors are independent of each other)?

10-year probability of hip fracture4

Age Probability

60 years 2.40%

70 years 7.87%

Risk factors and relative risk of hip fracture in white women5

Risk factor Relative risk (95% CI)

History of maternal hip fracture 2.0

Personal history of fracture 1.5

Current use of long-acting benzodiazepines 1.6

Current use of anticonvulsants 2.8

Being on your feet for <4 hours per day 1.7

Walks for exercise 0.7

a. Age 60, a history of maternal hip fracture, and a personal history of fracture

b. Age 70, a history of maternal hip fracture, and a personal history of fracture

c. Age 70, current use of long-acting benzodiazepines and anticonvulsants

d. Age 70, on their feet for less than 4 hours a day, and current use of long-acting benzodiazepines

e. Age 70, walks for exercise, and a personal history of any fracture since age of 50

6. You have just diagnosed polymyalgia rheumatica in a 67 year old woman. She was well previously with no other significant medical history. You intend to treat her with oral prednisolone, starting with 20 mg a day, then reducing it to 10 mg a day after one month, and then to as low a dose as possible thereafter. You expect that she will have to continue the treatment for two or more years. According to guidance from the Bone and Tooth Society, The Royal College of Physicians and the National Osteoporosis Society, which of the following is the most appropriate course of action?6

a. Treat with prednisolone alone

b. Treat with a bone-preserving therapy from the outset

c. Treat with