Glucocorticoid-Induced Osteoporosis: A Quiz

January 29, 2018

How best to protect your patients at risk for fracture? Test your knowledge with this 10-question quiz.

A 35-year-old woman with rheumatoid arthritis, a 63-year-old man with poorly controlled asthma, a 48-year-old woman with inflammatory bowel disease-what do these patients have in common? All are at increased risk for osteoporosis as a result of long-term glucocorticoid therapy

Because of their anti-inflammatory and immunosuppressive effects, glucocorticoids remain a cornerstone of treatment for patients with a variety of inflammatory diseases. However, adverse effects of long-term glucocorticoid therapy are common: osteoporosis and associated fractures are among the most serious.

The American College of Rheumatology (ACR) recently updated its guidelines to help you combat glucocorticoid-induced osteoporosis.1 Test your knowledge of the ACR's recommendations with this 10-question quiz.

 

1. When does the highest rate of bone loss occur during long-term (≥ 3 months) glucocorticoid therapy?A. The first 1 to 3 months of therapy
B. The first 3 to 6 months of therapy
C. The first 6 to 9 months of therapy
D. The first 9 to 12 months of therapy

The correct answer is B. The first 3 to 6 months of therapy.

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2. What percentage of patients who receive long-term glucocorticoid therapy have radiographic evidence of vertebral fractures?
A.
10% to 20%
B. 20% to 30%
C. 30% to 40%
D. 40% to 50%

The correct answer is C. 30% to 40%.

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3. A clinical fracture is diagnosed in what percentage of patients who receive long-term glucocorticoid therapy?
A.
More than 10%
B. More than 15%
C. More than 20%
D. More than 25%

The correct answer is A. More than 10%.

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4. When should the risk of clinical fracture initially be assessed in adults and children who are starting long-term glucocorticoid therapy?
A.
As soon as possible
B. As soon as possible, but at least within 3 months of the start of treatment
C. As soon as possible, but at least within 6 months of the start of treatment.
D. Within 1 year of the start of treatment

The correct answer is C. As soon as possible, but at least within 6 months of the start of treatment.

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5. In adults and children who continue glucocorticoid therapy, when should a reassessment of clinical fracture risk be performed?
A.
Every 6 months
B. Every 12 months
C. Every 18 months
D. Every 24 months

The correct answer is B. Every 12 months.

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6. Which of the following risk factors places both younger and older adults at high risk for fracture?
A
. Prior osteoporotic fracture
B. Hip or spine bone mineral density T score ≤ -2.5 in men age ≥ 50 years and postmenopausal women
C. FRAX (glucocorticoid-adjusted) 10-year risk of major osteoporotic fracture ≥ 20%
D. FRAX (glucocorticoid-adjusted) 10-year risk of hip fracture ≥ 3%

The correct answer is A. Prior osteoporotic fracture.

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7. What is the recommended calcium intake for all patients who are receiving glucocorticoid treatment?
A.
400 to 600 mg/d
B. 600 to 800 mg/d
C. 800 to 1000 mg/d
D. 1000 to 1200 mg/d

The correct answer is D. 1000 to 1200 mg/d.

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8. What is the recommended vitamin D intake for all patients who are receiving glucocorticoid treatment?
A.
400 to 600 IU/d
B. 600 to 800 IU/d
C. 800 to 1000 IU/d
D. 1000 to 1200 IU/d

The correct answer is B. 600 to 800 IU/d.

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9. For adults age 40 and older (women not of childbearing potential and men) who are at moderate to high risk for fracture, what is the recommended initial pharmacologic treatment?
A.
Oral bisphosphonate
B. Intravenous bisphosphonate
C. Teriparatide
D. Denosumab

The correct answer is A. Oral bisphosphonate.

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10. For which patients at moderate to high risk for fracture is raloxifene considered to be a treatment option?
A.
For all women
B. For all women age 40 years and older
C. For all postmenopausal women
D. Only for postmenopausal women with contraindications to all other pharmacologic treatments

The correct answer is D. Only for postmenopausal women with contraindications to all other pharmacologic treatments.

References:

1. Buckley L, Guyatt G, Fink HA, et al. 2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis.Arthritis Rheumatol. 2017;69:1521-1537.