Previous year question on osteoporosis based on neet pg, usmle, plab and fmge or mci screening exams

Which of the following investigation is considered to be the gold standard in the diagnosis of osteoporosis?

A: UltrasoundB: Dual energy X-ray absorptiometryC: Single energy X-ray absorptiometryD: Quantitative computed tomography

Correct Ans:BExplanation

Osteoporosis is a group of disorders characterized by reduced bone mass or density in the absence of defect in bone mineralization. Dual energy X ray Absorptiometry (DEXA) scan is the gold standard method in the diagnosis of osteoporosis. It is a quantitative method for measuring bone mass by using low energy X ray beam. Using this method bone mass is measured in units of gram per cubic centimeter of bone. WHO criteria for osteoporosis is a DEXA scan T score at or below -2.5. T score between +1 and -1 indicates normal bone, between -1 and -2.5 indicates osteopenia.

Ref: Internal Medicine: An Illustrated Radiological Guide By Jarrah Ali Al-Tubaikh, Page 219

Sample Previous Year Question on Osteoporosis from Pathology based on previous Year Questions of NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org for more such Quizzes

Which of the following is an absolute contraindication to adrenal steroid therapy?

A: Severe hypertensionB: Osteoporosis

C: Diabetes mellitusD: Cushing's syndromeCorrect Ans:DExplanation

Cushing's syndrome is an absolute contraindication to corticosteroid therapy. Relative contraindications includes peptic ulcer, hypertension, hypertension with congestive heart failure, diabetes mellitus, herpes simplex infection, osteoporosis and glaucoma.

Ref: Textbook of Pharmacology By Seth 3rd edition page 61


Calcitonin is used in all of the following conditions, EXCEPT:

A: Hypervitaminosis DB: Postmenopausal osteoporosisC: Paget's diseaseD: Fanconi syndromeCorrect Ans:DExplanation

The ability of calcitonin to block bone resorption and lower serum calcium makes it a useful drug for the treatment of Paget's disease, hypercalcemia, and osteoporosis.

Fanconi syndrome is a disease of the proximal renal tubules of the kidney in which glucose, amino acids, uric acid, phosphate and bicarbonate are passed into the urine, instead of being reabsorbed. Treatment of children with Fanconi syndrome mainly consists of replacement of substances lost in the urine (mainly fluid and bicarbonate). Calcitonin is not indicated in this disease.

In paget's disease bisphosphonates and calcitonin decrease the elevated biochemical markers of bone turnover, such as plasma alkaline phosphatase activity and urinary excretion of hydroxyproline.

Ref: Bikle D.D. (2012). Chapter 42. Agents that Affect Bone Mineral Homeostasis. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.


Which of the following drugs used in osteoporosis acts both by decreasing the resorption of bone as well as inducing new bone formation?

A: TeriparatideB: IbandronateC: Strontium ranelateD: Calcitonin

Correct Ans:CExplanation

Strontium ranelate appears to block differentiation of osteoclasts while promoting their apoptosis, thus inhibiting bone resorption. At the same time, strontium ranelate appears to promote bone formation. Unlike bisphosphonates, denosumab, or teriparatide, this drug increases bone formation markers while inhibiting bone resorption markers.

Calcitonin inhibits osteoclastic bone resorption. Although bone formation is not impaired at first after calcitonin administration, with time both formation and resorption of bone are reduced.

Ref: Bikle D.D. (2012). Chapter 42. Agents that Affect Bone Mineral Homeostasis. In B.G. Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical Pharmacology, 12e.


Glucocorticoids causes all, except :

A: Muscle wastingB: OsteoporosisC: Diabetes mellitusD: Reduced appetiteCorrect Ans:DExplanationGlucocorticoid excess leads to bone dissolution by decreasing bone formation and increasing bone resorption. This leads to osteoporosis, a loss of bone mass that leads eventually to collapse of vertebral bodies and other fractures.Glucocorticoids in excess accelerate the basic electroencephalographic rhythms and produce mental aberrations ranging from increased appetite, insomnia, and euphoria to frank toxic psychoses. Many of the amino acids liberated from catabolized proteins are converted into glucose in the liver and the resultant hyperglycemia and decreased peripheral utilization of glucose may be sufficient to precipitate insulin-resistant diabetes mellitus, especially in patients genetically predisposed to diabetes. Patients with excess Glucocorticoids are protein-depleted as a result of excess protein catabolism. The skin and subcutaneous tissues are therefore thin and the muscles are poorly developed.

Ref :Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 20. The Adrenal Medulla & Adrenal Cortex. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e.


A 52 year old woman presents to her physician for a check-up. She is recovering from a wrist fracture after a fall. Dual energy x-ray absorptiometry of the hip had shown her to have osteoporosis. She became menopausal at age 50 and did not begin hormone

replacement therapy because of a strong family history of breast cancer. She now fears a future hip fracture and would like to begin a bone loss prevention regime.Which of the following pharmaceutical agents is most appropriate for this patient?

A: Calcitonin nasal sprayB: Oral conjugated estrogenC: RaloxifeneD: TamoxifenCorrect Ans:CExplanationRaloxifene is a selective estrogen receptor modulator that helps prevent osteoporosis by lessening bone resorption and reducing bone turnover. It lowers risk for vertebral fractures by 40% to 50%. It is a bone-preserving alternative for women who prefer to avoid estrogen. Raloxifene does not cause breast pain and may lessen the risk for breast cancer in menopausal women. There is also a favorable effect on LDL and cholesterol.

Calcitonin nasal spray is an osteoclastic bone resorption inhibitor that modestly increases bone mineral density and reduces the incidence of vertebral fracture. Although it is an estrogen alternative for bone preservation, its impact on hip fracture is not known. It is also lacks the anti-breast cancer properties of raloxifene.

Oral conjugated estrogen and transdermal estradiolare not the best choices, as this patient wants to avoid estrogen because of a strong family history of breast cancer. The route of administration of estrogen has been shown to have similar effects on bone preservation, even though the transdermal dosage is generally half that of the oral dosage. Breast cancer risk, however, is slightly increased with the unopposed higher dosage oral estrogen replacement.

Tamoxifen , while indicated in the long-term care of breast cancer patients, is not alone useful for treatment or prevention of osteoporosis. Tamoxifen is an anti-estrogen agent that competes with estrogen for binding sites.

Ref: Shoback D. (2013). Chapter 58. Osteoporosis & Glucocorticoid-Induced Osteoporosis. In J.B. Imboden, D.B. Hellmann, J.H. Stone (Eds), CURRENT Diagnosis & Treatment: Rheumatology, 3e.


Which among the following is the causative factor for forming ‘Gutter wound’?

A: Oblique bullet woundB: Fall from heightC: Sharp weaponD: Osteoporosis

Correct Ans:A

ExplanationBullets may graze or rub the top and sides of the cranium without entering it. In such cases, entry and exit wounds are found on the scalp about two to three cm. apart, while the skull between the two wounds shows an oval or elongated gutter-like depression, known as ‘gutter wound’. Ref: The Essentials of Forensic Medicine and Toxicology by KS Narayan Reddy, 27th edition, Page 201.


A child was exposed to excess fluoride in drinking water for a long time. What will be the earliest manifestation of fluorosis in this child?

A: ARDSB: Delayed speech developmentC: Mottled enamelD: Osteoporosis

Correct Ans:CExplanationIn humans, the major manifestations of chronic ingestion of excessive fluoride are osteosclerosis and mottled enamel. Mottling is one of the first visible signs of excess fluoride intake during childhood. Continuous use of water containing ~1 ppm of fluoride may result in very mild mottling in 10% of children; at 4-6 ppm the incidence approaches 100%, with a marked increase in severity. Osteosclerosis is characterized by increased bone density secondary both to elevated osteoblastic activity and to the replacement of hydroxyapatite by the denser fluorapatite. Ref: Friedman P.A. (2011). Chapter 44. Agents Affecting Mineral Ion Homeostasis and Bone Turnover. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.


Brown’s tumour is seen in:

A: HyperthyroidismB: HyperparathyroidismC: OsteoporosisD: Osteogenesis imperfectaCorrect Ans:BExplanationAdvanced primary hyperparathyroidism pathognomonic radiologic findings, which are best seen on x-rays of the hands and are characterized by subperiosteal resorption. The skull also may be affected and appears mottled with a loss of definition of the inner and outer cortices. Brown or osteoclastic tumors and bone cysts also may be present.

Ref: Schwartz’s principle of surgery 9th edition, chapter 38.


Subperiosteal resorption that is most apparent on the radial aspect of the middle phalanx of the second and third fingers is seen in:

A: HyperthyroidismB: HyperparathyroidismC: OsteoporosisD: Osteogenesis imperfectaCorrect Ans:BExplanationAdvanced primary hyperparathyroidism with osteitis fibrosa cystica now occurs in <5% of patients.

It has pathognomonic radiologic findings, which are best seen on x-rays of the hands and are characterized by subperiosteal resorption (most apparent on the radial aspect of the middle phalanx of the second and third fingers), bone cysts, and tufting of the distal phalanges.

Ref: Schwartz’s principle of surgery 9th edition, chapter 38.


Intranasal calcitonin is given for a 65 year old post-menopausal lady. What is the likely indication?

A: Paget's diseaseB: OsteoporosisC: HypercalcemiaD: Osteopetrosis


Calcitonin-salmon is a hormone that decreases osteoclast activity, thereby impeding postmenopausal bone loss. It is indicated for the treatment of women who are more than 5 years post menopause and have low bone mass relative to healthy premenopausal women. It is available as an injection and as an intranasal spray. The intranasal spray is delivered as a single daily spray that provides 200 IU of the drug.


A female is on hormone replacement therapy for her menopausal symptoms. She is worried about her bone strength because her mom and sister had osteoporosis after the age of 50. All are given for prevention of osteoporosis along with hormonal replacement therapy, EXCEPT:

A: CalciumB: Vit.D

C: Vitamin-ED: None of the aboveCorrect Ans:CExplanation

Women most at risk for osteoporotic fractures should consider bisphosphonates, raloxifene, along with hormone replacement therapy. Elemental calcium should be taken as a daily supplement at the time of the menopause and thereafter; calcium supplements should be taken with meals to increase their absorption. Vitamin D, sunlight, or supplements, is necessary to enhance calcium absorption and maintain bone mass.

Ref: MacKay H., Woo J. (2013). Chapter 18. Gynecologic Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow, T.G. Berger (Eds), CURRENT Medical Diagnosis & Treatment 2014.


All of the following are associated with polycystic ovarian syndrome, EXCEPT:

A: Ovarian carcinoma

B: Ovarian carcinoma

C: Insulin Resistance

D: Osteoporosis

Correct Ans:DExplanationOsteoporosis does not occur as a complication of Polycystic Ovarian Syndrome (PCOS). Women with PCOS have high level of estrogen, so not at risk of developing osteoporosis, but at risk of endometrial hyperplasia leading to adenocarcinoma and cancer of breast. Ref: Willaim's Gynaecology, 1st Edition, Page 385, 391; Novak's, 14th Edition, Page 1082, 1077; Polycystic Ovary Syndrome By Hamburg, 2nd Edition, Page 191; Polycystic Ovary Syndrome By Dutta, 1st Edition, 2004, Page 18.


All of the following are associated with polycystic ovarian syndrome, EXCEPT:

A: Ovarian carcinomaB: Endometrial carcinomaC: Insulin ResistanceD: Osteoporosis

Correct Ans:DExplanationOsteoporosis does not occur as a complication of Polycystic Ovarian Syndrome (PCOS). Women with PCOS have high level of estrogen, so not at risk of developing osteoporosis, but at risk of endometrial hyperplasia leading to adenocarcinoma and cancer of breast.

Ref: Willaim's Gynaecology, 1st Edition, Page 385, 391; Novak's, 14th Edition, Page 1082, 1077; Polycystic Ovary Syndrome By Hamburg, 2nd Edition, Page 191; Polycystic Ovary Syndrome By Dutta, 1st Edition, 2004, Page 18.


A 48 years old female suffering from severe menorrhagia (DUB) underwent hysterectomy. She wishes to take hormone replacement therapy. Physical examination and breast are normal but X-ray shows osteoporosis. The treatment of choice is:

A: ProgesteroneB: Estrogen progesteroneC: EstrogenD: None


Osteoporosis in this patient is due to estrogen deficiency. Estrogens are efficacious when administered orally or transdermally. Various types of estrogens (conjugated equine estrogens, estradiol, estrone, esterified estrogens, ethinyl estradiol, and mestranol) reduce bone turnover, prevent bone loss, and induce small increases in bone mass of the spine, hip, and total body. The effects of estrogen are seen in women with natural or surgical menopause and in late postmenopausal women with or without established osteoporosis.

Ref: Lindsay R., Cosman F. (2012). Chapter 354. Osteoporosis. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.


You are about to give intraosseous infusion in a child. Which of the following need NOT be ruled out before giving the infusion?

A: OsteoporosisB: Septic shock

C: Osteogenesis imperfectaD: Fracture at the site of insertionCorrect Ans:BExplanation

Intraosseous transfusion may be required if intra vascular access is not available in conditions like severe burns, septic shock, prolonged status epilepticus, cardiopulmonary arrest etc.

Also knowComplications of intraosseous transfusiona) Extravasation of fluidsb) Cellulilitsc) Osteomyelitisd) Fat or bone micro embolism

Ref: Oxford Handbook Of Clinical Specialities, Edition 8, Page - 263.


The success of estrogen and estrogen-like drugs in combating osteoporosis in postmenopausal women may indicate that estrogen:

A: Stimulates osteoclastic activityB: Inhibits osteoclastic activity

C: Inhibits osteoblastic activityD: Inhibits recalcification during bone turnoverCorrect Ans:BExplanation

Estrogens directly regulate osteoblasts and increase the synthesis of type I collagen, osteocalcin, osteopontin, osteonectin, alkaline phosphatase, and other markers of differentiated osteoblasts. Estrogens also increase osteocyte survival by inhibiting apoptosis. However, the major effect of estrogens is to decrease the number and activity of osteoclasts.

Much of the action of estrogens on osteoclasts appears to be mediated by altering cytokine (both paracrine and autocrine) signals from osteoblasts. Estrogens decrease osteoblast and stromal cell production of the osteoclast-stimulating cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)- and increase the production of IGF-1, bone morphogenic protein (BMP)-6, and transforming growth factor (TGF) Beta which are antiresorptive.

Ref: Levin E.R., Hammes S.R. (2011). Chapter 40. Estrogens and Progestins. In L.L.

Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e.


Regarding: Colles fracture

Assertion: Colles fracture occur mainly in women at the proximal end of radius at its cortico cancellous junction.

Reason: It is common in women because of postmenopausal osteoporosis.

A: Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

B:Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

C: Assertion is true, but Reason is falseD: Assertion is false, but Reason is trueCorrect Ans:DExplanation

Colles fracture is a fracture at the distal end of radius at its cortico cancellous junction. It is the commonest fracture in women above 40 years of age because of postmenopausal osteoporosis.

Ref: Essentials of Orthopedics By Maheswari, 3rd Edition, Page 93


A 38-year old lady presents with h/o backache. X-ray and MRI spine reveal collapse of D12 vertebra with normal intervertebral disc space. The LEAST likely diagnosis is:

A: Multiple myelomaB: OsteoporosisC: TuberculosisD: Metastasis

Correct Ans:C

Explanation

Imaging findings of TB spine or Pott’s disease:

Most commonly involves the anterior part of the vertebral bodies in the thoracic and lumbar region.

Irregular, poorly marginated bone destruction in a vertebral body, with narrowing of the adjacent intervertebral disk.

Extension of infection and bone destruction across the disk to involve the contiguous vertebral body.

Collapses secondary to osteoporosis, multiple myeloma and metastases primarily involve the T11-L4 region. Primarily anterior wedging of the superior endplate of a vertebral body will be present.

Ref: Clinical Imaging: An Atlas of Differential Diagnosis By Ronald L. Eisenberg, 2009, Page 1192, 1193.


Which among the following is not seen in inflammatory arthritis?

A: Raised ESRB: Morning stiffnessC: Periarticular osteoporosisD: New bone formation

Correct Ans:DExplanation

New bone formation i.e osteophyte formation is seen in non inflammatory conditions like osteoarthritis.

Raised ESR, morning stiffness in and around the joints lasting for more than 30 minutes, periarticular osteoporosis are features of inflammatory arthritis. The joint space narrowing, and marginal erosions are also seen.


A 35-year-old woman consults a physician because of increasing discomfort in her hands over the past year. Her symptoms have developed insidiously and are often worst for the first hour after rising. She has also been experiencing vague symptoms of fatigue and

malaise, particularly in the early afternoon. Physical examination of her hands is notable for tenderness and synovial thickening of most of the small hand joints of both hands, particularly the proximal interphalangeal and metacarpophalangeal joints. A number of joints elsewhere, including in the feet, elbows, and ankles, are also symmetrically involved. An autoantibody directed against lgG is detected in serum. Which of the following is the most likely diagnosis?

A: OsteoarthritisB: OsteomyelitisC: OsteoporosisD: Rheumatoid arthritisCorrect Ans:DExplanation

This woman most likely has rheumatoid arthritis (RA). This chronic syndrome is characterized by inflammation of peripheral joints, and may or may not be accompanied by systemic manifestations. The American Rheumatism Association has put out revised criteria for the diagnosis of rheumatoid arthritis that require at least 4 of the following for diagnosis: morning stiffness for one hour or longer, arthritis of three or more joints, arthritis of hand joints, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor (RF; anti-IgG) present, and characteristic radiographic changes.

In gout, the hands are usually spared, with common sites of involvement including the foot (typically the great toe), knee, wrist, and elbow.

Osteoarthritis usually produces only a short period of morning stiffness and commonly involves the distal as well as proximal interphalangeal joints, vertebral column, hip, and knee.

Osteomyelitis may involve vertebrae, feet (usually in diabetics), or the metaphyses of the tibia or femur (more common in children).

Osteoporosis causes bone loss, and is usually painless unless a fracture occurs.


Which of the following is the most frequent presentation of osteoporosis?

A: Weight lossB: Bowing of legsC: Vertebral compression fractureD: Low serum calcium level


Compression fracture or collapse of vertebrae resulting in back ache is the usual symptom of osteoporosis. Osteoporosis is a skeletal disorder characterized by a loss of bone osteoid that reduces bone integrity resulting in increased risk of fractures. It is associated with normal serum calcium, phosphate and parathyroid hormone level.

Reference:

Current Medical Diagnosis and Treatment 2013, chapter 26.


An 88-year-old woman is brought to the casualty by her family after a fall 12 hours prior to presentation. She complains of pain in her left wrist, leg, and lower back. She has recently been told by her PHC doctor that she has osteoporosis. On physical examination, her left wrist is tender and has a deformity. She is tender in her low lumbar region. Her left lower extremity is shortened and externally rotated. She is has normal motor strength, sensation, and pulses in her upper and lower extremities. X-ray films reveal a dorsally angulated and displaced fracture of her distal radius. X-ray films of her lumbar spine reveal a compression fracture of the T12 vertebra. X-ray films of her left leg reveal a left femur fracture. The basic abnormality affecting this patient's bones is which of the following?

A: Abnormal collagen synthesis and failure of crosslinking

B: Abnormal collagen synthesis with normal crosslinkingC: Reduction in bone formation with defective bone mineralizationD: Reduction in bone mass with normal bone mineralization


Osteoporosis is a reduction in bone mass with normal bone mineralization. There is a quantitative defect of bone. However, the bone that is present has normal mineralization.

Abnormal bone remodeling is characteristic of Paget disease.

This woman's condition is not due to abnormal collagen synthesis, with or without normal cross-linking. Abnormal collagen synthesis associated with a failure of cross-linking is the description of osteogenesis imperfecta.

Reduction in bone formation with defective bone mineralization is defined as osteomalacia.

Reduction in osteoclast function is the definition for osteopetrosis, or Marble bone disease.


Marble bone disease is an inherited disease of the skeleton which is accompanied by an increase in calcified bone tissue. It is also known as:

A: OsteoporosisB: OsteochondritisC: OsteopetrosisD: Osteogenesis imperfectaCorrect Ans:CExplanation

Osteopetrosis or Albers-Schonberg Disease or Marble Bone Disease is an inherited disease of the skeleton which is accompanied by an increase in calcified bone tissue - namely osteosclerosis. The bone marrow cavity is almost completely filled with compact bone tissue and cortex is thickened by periosteal bone deposition. Radiologically the bones are accordingly seen as complete shadows which give the name marble bone disease.

The pathogenesis is insufficiency of osteoclasts. Hence the bone resorption is inadequate. The primary spongiosa is not transformed into a secondary spongiosa. X-ray of lumbar spine shows ‘sandwich vertebra’.

Ref: Bone diseases: macroscopic, histological, and radiological diagnosis By Claus-Peter Adler, 2000, Page 54


Which of the following biochemical findings are seen in osteoporosis?

A: Low Ca, high P04. high alkaline phosphataseB: Low Ca. low P04. low alkaline phosphataseC: Normal Ca, normal PO4, normal alkaline phosphataseD: Low Ca, low P04, normal alkaline phosphatase


In osteoporosis the levels of calcium, PO4, alkaline phosphatase and parathyroid hormone are normal. Vitamin D deficiency is commonly associated with this condition.

Osteoporosis is a skeletal disorder characterized by a loss of bone osteoid that reduces bone integrity, resulting in an increased risk of fractures. Most common causes are aging, use of steroids, alcoholism, smoking and sex hormone deficiency. According to WHO, osteoporosis is defined as a bone density that falls 2.5 standard deviations (SD) below the mean for young healthy adults of the same sex.

Ref: Fitzgerald P.A. (2013). Chapter 26. Endocrine Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow, T.G. Berger (Eds), CURRENT Medical Diagnosis & Treatment 2014.


60 yrs old male with bony abnormality at upper tibia associated with sensorineural hearing loss. On laboratory examination serum alkaline phosphatase levels are (440 mU/1) elevated and serum Ca2+ and P042- are normal. Skeletal survey shows ivory vertebrae and cotton wool spots in x-ray skull. Diagnosis is:

A: Fibrous dysplasiaB: Paget diseaseC: Osteosclerotic metastasisD: Osteoporosis


Serum alkaline phosphatase (ALP) is in Paget's disease elevated but calcium, parathyroid hormone, 25-hydroxyvitamin D, and 1,25-dihydroxyvitamin D levels are normal. Cranial

expansion may narrow cranial foramens and cause neurologic complications including hearing loss from cochlear nerve damage from temporal bone involvement.

Skull radiographs reveal regions of "cotton wool," or osteoporosis circumscripta, thickening of diploic areas, and enlargement and sclerosis of a portion or all of one or more skull bones. Vertebral cortical thickening of the superior and inferior end plates creates a "picture frame" vertebra. Diffuse radiodense enlargement of a vertebra is referred to as "ivory vertebra."

Ref: Favus M.J., Vokes T.J. (2012). Chapter 355. Paget's Disease and Other Dysplasias of Bone. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds),Harrison's Principles of Internal Medicine, 18e.


A 49 year old female was prescribed hormone replacement therapy (HRT). HRT is useful in all of the following, EXCEPT:

A: FlushingB: OsteoporosisC: Vaginal atrophyD: Coronary heart diseaseCorrect Ans:DExplanation

Benefits and Risks of Postmenopausal Hormone Therapy (HT):

Definite Benefits

Symptoms of menopause (e.g, Flushing, vaginal atrophy) Osteoporosis

Definite Risks

Endometrial cancer Venous thromboembolism Breast cancer Gallbladder disease

Probable or Uncertain Risks and Benefits

Coronary heart disease

Stroke Ovarian cancer Colorectal cancer Diabetes mellitus Cognitive dysfunction

Ref: Manson J.E., Bassuk S.S. (2012). Chapter 348. The Menopause Transition and Postmenopausal Hormone Therapy. In Longo D.L., Fauci A.S., Kasper D.L., Hauser S.L., Jameson J, Loscalzo J (Eds), Harrison's Principles of Internal Medicine, 18e.


Which of the following statement regarding Rheumatoid arthritis is false?

A: It is symmetrical involving small and large jointsB: Pulmonary nodules are presentC: Juxta articular osteoporosis may be presentD: None of the above


Rheumatoid arthritis is a chronic systemic inflammatory disease, with symmetric involvement of small and large joints. Joint stiffness lasting for more than 30minutes is the prominent symptom. Characteristic Xray findings include

juxta articular osteoporosis, joint erosions and joint space narrowing. Rheumatoid factor and antibodies to citrullinated peptides are seen in 70 - 80% cases.

Reference:

Harrison's Principles of Internal Medicine 18e chapter 321.


Which of the following immunosuppresive agents have a side effect of osteoporosis?

A: CyclophosphamideB: Methotrexate

C: GlucocorticoidsD: Mycophenolate mofetilCorrect Ans:CExplanationSide effects of common Immuno-Suppresants are given below:

Cyclophosphamide: Leucopenia or neutropenia, infections (usually respiratory and urinary tract), infertility, cancer (especially bladder cancer and leukaemia), haemorrhagic cystitis, alopecia, and amenorrhoea

Glucocorticoids: Osteoporosis, candida infection (oral and vaginal), other infections, weight gain, hyperglycaemia or diabetes, hypertension, cushingoid appearance, skin atrophy, and cataract

Azathioprine: Nausea, leucopenia or neutropenia, infection, hypersensitivity, cancer, alopecia, cholestasis, and thrombocytopenia

Methotrexate: Nausea, oral ulcers, liver dysfunction, infection, hypertension, leucopenia

Mycophenolate mofetil: infection, leucopenia, gastrointestinal tract manifestations, anaemia, thrombocytopenia

Rituximab: Infections (encephalitis is particularly dangerous), cancer, anaemia, neutropenia, thrombocytopenia, hypogammaglobulinaemia

Ref: Diagnosis and management of ANCA associated vasculitis ; BMJ 2012;344:e26


A 58 years old woman, who had backache and recurrent chest infections for 6 months, develops sudden weakness of the legs and urinary retention. His investigations show a hemoglobin of 7.3 gm/dl, serum calcium 12.6 mg/dl, phosphate-2.5 mg/dl, alkaline phosphatase-100 u/1, serum albumin-3 gm/dl, globulin-7.1 gm/dl and urea-178 mg/d. What is the most likely diagnosis?

A: Lung cancerB: Disseminated tuberculosisC: Multiple myelomaD: Osteoporosis


The above mentioned features are consistent with the diagnosis of mutiple myeloma. So multiple myeloma is the single best answer of choice.

Ref: Harrison's Principles of Internal Medicine, 16th Edition Pages 657-60; Ferri’s Clinical Advicer, 2009, Page 589.


A 58 years old woman, who had backache and recurrent chest infections for 6 months, develops sudden weakness of the legs and urinary retention. His investigations show a hemoglobin of 7.3 gm/dl, serum calcium 12.6 mg/dl, phosphate-2.5 mg/dl, alkaline phosphatase-100 u/1, serum albumin-3 gm/dl, globulin-7.1 gm/dl and urea-178 mg/d. What is the most likely diagnosis?

A: Lung cancerB: Disseminated tuberculosisC: Multiple myelomaD: Osteoporosis


The above mentioned features are consistent with the diagnosis of mutiple myeloma. So multiple myeloma is the single best answer of choice.

Ref: Harrison's Principles of Internal Medicine, 16th Edition Pages 657-60; Ferri’s Clinical Advicer, 2009, Page 589.


All of the following are the known causes of osteoporosis except:

A: FluorosisB: HypogonadismC: HyperthyroidismD: HyperparathyroidismCorrect Ans:AExplanation

All the conditions mentioned above causes osteoporosis except flurosis. Flurosis is associated with osteosclerosis. So fluorosis is the single best answer of choice.

Ref: Harrisons Principles of Internal Medicine, 16th Edition, Pagse 410, 2271.


Which of the following condition is not associated with osteoporosis?

A: ImmobilizationB: Thyrotoxicosis

C: Turner’s syndromeD: HypoparathyroidismCorrect Ans:DExplanation

Osteoporosis is associated with hyperparathyroidism. In hyperparathyroidism, excess parathyroid hormone in the blood stimulates extraction of calcium from bone to blood stream resulting in osteoporosis.


Which of the following conditions are associated with osteoporosis?

A: Cushing’s syndromeB: Anorexia nervosa

C: AcromegalyD: All the aboveCorrect Ans:DExplanation

Cushing's syndrome, anorexia nervosa and acromegaly are all associated with osteoporosis. Other endocrine disorders associated with osteoprosis are hyperparathyroidism, thyrotoxicosis, type 1 diabetes and adrenal insufficiency.


A patient with diabetic nephropathy developed secondary hyperparathyroidism. Hyperthyroidism is seen in all of the following conditions, EXCEPT:

A: OsteoporosisB: OsteomalaciaC: RicketsD: Chronic renal failureCorrect Ans:AExplanation

In chronic kidney disease, hyperphosphatemia and decreased renal production of 1,25-dihydroxycholecalciferol (1,25[OH]2D3) initially produce a decrease in ionized calcium. The parathyroid glands are stimulated (secondary hyperparathyroidism) and may enlarge, becoming autonomous (tertiary hyperparathyroidism).In osteomalacia and rickets, hypocalcemia acts as stimulus to secondary hyperparathyroidism.

Ref: Shoback D., Sellmeyer D. (2011). Chapter 8. Metabolic Bone Disease. In D.G. Gardner, D. Shoback (Eds), Greenspan’s Basic & Clinical Endocrinology, 9e.


Which of the following is not seen in Chronic Regional Pain Syndrome?

A: AnhydrosisB: Pain

C: SwellingD: OsteoporosisCorrect Ans:AExplanation

Complex regional pain syndrome is usually associated with increased sweating (hyperhydrosis) and not anhydrosis. Pain and swelling are features of CRPS, while osteoporosis may present with CRPS. So the single best answer of choice is anhydrosis.

Ref: Harrison’s Principles of Internal Medicine, 16th Edition, Page 2433


All of the following can cause osteoporosis, EXCEPT:

A: SteroidsB: FluorosisC: ThyrotoxicosisD: HyperparathyroidismCorrect Ans:BExplanationOsteoporosis is a skeletal disorder characterized by a loss of bone osteoid resulting in reduced bone integrity, thereby increasing the risk of fractures. Most common causes of osteoporosis are aging, highdose corticosteroid, thyrotoxicosis, hyperparathyroidism, alcoholism, sex hormone deficiency, particularly menopause in women, tobacco, etc.

Osteoporosis is caused by a reduction and disarray of bone's microarchitectural organic collagenous matrix, which accounts for 40% of bone mass and provides tensile strength. Calcium hydroxyapetite and phosphate compounds, mineralize the collagenous bone matrix and account for 60% of bone mass and bone's compressive strength.

It is usually asymptomatic until fractures occur. Patients present with backache of varying degrees of severity or spontaneous fracture or collapse of a vertebra.

Ref: Current Medical Diagnosis and Treatment, 2012, Chapter 26; Textbook Of Orthopaedics By Kotwal, Page 108


Strontium ranelate is approved for treatment of:

A: AsthmaB: Cystic fibrosisC: UTID: OsteoporosisCorrect Ans:DExplanationStrontium ranelate is approved in several European countries for the treatment of osteoporosis. It increases bone mass throughout the skeleton; in clinical trials, the drug reduced the risk of vertebral fractures by 37% and nonvertebral fractures by 14%. It appears to be modestly antiresorptive, while at the same time not causing as much of a decrease in bone formation (measured biochemically).

Ref: Harrison’s principle of internal medicine 17th edition, chapter 338.


Health & Medicine

Previous year question on osteoporosis based on neet pg, usmle, plab and fmge or mci screening exams