PT 8390 Case Management II
Osteoporosis Quiz, not for a grade
1.
T
Although osteoporotic bones are more porous than healthy bone,
the bone that is present is well calcified.
(Salter) This is in contrast to Osteomalacia “Rickets” in which the bone becomes demineralized
and soft.
True
F
2.
TF
False
Ovolacto Vegetarian diet increases the risk of osteoporosis.
(Marsh)
A study of 1600 women who at age 80 had been ovolacto
vegetarians for 20 years showed their bone loss to be 18%
compared to omnivores who lost 35%
4.
TF
False
A diet high in animal protein decreases the risk of osteoporosis.
(Marsh; Calvo; Draper; Germano) Calcium homeostasis may be upset
when high levels of phosphorous (in this case from protein) is taken in. A Ca:P ratio
greater than 1:2 causes bone loss in animal studies. Raising protein intake from 50g to
150g can double the amount of calcium excreted.
5.
TF
True
Over half of all girls under 15 don’t get enough calcium in their diet.
(Notelovitz)
6.
TF
Japanese live with a much lower bone density than Americans but sustain a lower rate of
osteoporotic fractures
True
(Germano)
It is postulated that a diet high in soy, sea vegetables, and moderate protein
intake may be a factor. Dairy products are commonly avoided.
7.
TF
Northern European have higher dairy consumption and lower rates
of osteoporotic fractures.
(Germano)
Northern Europeans have among the highest osteoporotic
fracture rate. In Scandinavian countries it has been recently speculated that the
average diet is too high in Vitamin A (from fish oils and as an additive) and that this
promotes increased rates of bone loss.
T F
True
By ethnic group the people who have the highest rate of lactose
intolerance are African Americans, followed by Hispanics, followed by Whites.
(Notelovitz)
Respectively the rates are 80%, 51%, and 21%
9.
TF
False
Yogurt has less lactose than milk or cheese.
(Notelovitz)
Cheese has nearly all the lactose removed as whey
10.
The oxalic acid present in green leafy vegetables such as spinach,
beet greens, and rhubarb increases the availability of the high levels of calcium that
they contain.
Oxalic acid binds the calcium and makes it less available. Examples of
green vegetable high in calcium that do NOT have significant levels of oxalic acid are:
brocolli (90mg Cal/1/2 cup), kale(100), collards(150), turnip greens(225), and
seaweeds(500-2000).
False
8.
TF
False
11.
False
T
F
Very strenuous and prolonged physical training can result in bone
loss for women, but not for men.
(Hetland; Hetland)
Bone loss can occur in both men and women.
Female triad: amenorrhea, anorexia, stress fracture
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12.
T
F
DEXA bone density scans may rate a falsely high bone mineral
density (BMD) score in patients with OA.
(Notelovitz)
Bone spurs and calcium nodules give the appearance of
higher density i.e. a false negative. Scoliosis and existing compression fractures will
similarly skew the results.
True
13.
T
F
Microscopic progressive compression fractures in the vertebrae
manifest as continuous chronic pain.
and True. Compression fracures may be the undiagnosed cause of chronic
back pain. However, vertebral compression fractures may be symptomatic or
asympromatic. Vertebral destruction can progress without pain for extended periods,
punctuated by acute episodes.
T
F
15.
False
T
F
Birth Control Pills increase the risk of bone loss.
(Notelovitz p.61)
Estrogen and progesterone enhance bone density.
16.
T
F
17.
True
T
F
Low levels of sex hormones can cause osteoporosis in women and men.
For women, estrogen levels drop with menopause. For men low
testosterone, also called hypogonadism,can be the results of genetics or or the aging
process.
18.
T
F
False
14.
False
Radiation exposure from a DEXA is greater than that received
from dental X rays.
(Notelovitz)
DEXA exposure is 2-4 mrem, while a dental X ray is 300 mrem. CXR = 25
Before rarefaction would be evident on a standard X ray, at least one third of the
BMD would already have been lost.
True
The metaphyses of long bones largely consist of cancellous or
trabecular bone
True
19. T
False
20.
F
High impact exercise is useful both in the prevention and treatment of osteoporosis.
(Meeks) Numerous studies indicate the benefit of high impact exercise for prevention,
however with pre existing osteoporosis, the risk of fracture is too great to justify potential benefits.
T
F
Patients on bed rest lose BMD at the rate of 1% per week, but recover it only at a rate of 1% per month.
(Krolner)
True
21.
T
True
22.
TF
The National Osteoporosis Foundation recommends a lifting
restriction of 20# for people with osteoporosis.
However if vertebral deformity is present, the recommended lifting limit
is 10# (Vaughan).
TF
Pain radiating around the chest wall from a wedge compression fracture is
True
23.
F
Postmenopausal bone loss can be 2-8% per year for the first 5 years, while non
hormonal age-related loss is 0.5% per year.
(Dowd) (Secondary = steroid induced, etc.)(the most rapid postmenopausal loss occurs in
the first5-7 years)
2
due to nerve root compression.
False
(McClung) The cause of pain could be due to referred periosteal trauma and muscle
spasms. Since spinal nerves exit posterior to the vertebral body, unless there was a crush or burst fracture
involving the posterior portion of the body (along with the anterior part) they are not likely to be affected.
25.
TF
False
Vertebral fractures have a longer healing time compared to
extremity fractures.
The healing time is comparable.
26. T F
True
25% of all women who have a hip fracture die within the first year.
(Baker) However,another source gives the mortality rate as high as 50%
27.
Half of all women and one eigth of all men will suffer osteoporotic
fractures.
TF
True
28. T F
False
A person with osteoporosis and kyphosis cannot recover height that has been lost.
(Meeks) Clinical experience shows that up to one to two inches in height
can be gained or restored through a comprehensive regimen of diet, medicine and PT.
29. T F
A person can lose spinal height without exhibiting kyphotic posture.
True
Disc dehydration may be the cause of spinal height loss, unrelated to osteoporosis. Also,
bi-concave (codfish) [Marilyn: younger person with osteomalacia: hydrated disc and soft bodies] and crush
vertebral fractures [MVA, SCI] will cause the loss of spinal height, but not the resulting kyphosis of the
more common wedge compression fractures
Height can also be lost due to: thinning of cartilage in weight bearing joints, and forefoot pronation..
30. T F
False
Cortical bone is not diminished from osteoporosis.
(Aisenberry) While cancellous bone is the most metabolically active and the first to
decrease, with advanced cases the cortical bone will also thin.
31. T F
True
BMD in elite swimmers does not differ from non-athletic controls.
(Nilsson) The strenous resistive exercise is insufficient to compensate
for the lack of weight bearing exercise.
32. T F
True
BMD in professional bicyclists is lower than non-athletic controls.
(Sabo) Tour de France bicyclists(n = 8) showed decreased bone mass of 10%
at the L spine and a decrease of 14% at the hip relative to age matched normals.
33.
In the mature adult 25% of the cancellous bone is renewed every
year, but only 3% of the cortical bone is renewed.
TF
True
34. T F
Low levels of Vitamin D impair the absorption of calcium from the
gut. This results in less calcium being resorbed from the bones.
False
When serum calcium levels fall (in this case due to poor absorption from the gut because of
inadequate Vitamin D), calcium is withdrawn from the “bone bank” to maintain homeostasis in the blood to
be made available for prioritized organ systems in the body such as heart, muscles, and nerves. The
parathyroid gland release PTH to accomplish this.
35. T F
True
When cortical bone is lost it results in increased endosteal
diameter.
And when cancellous bone is lost, the trabeculae are thinned.
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36. T F
True
Fracture risk increased two to three fold for every drop of 1 SD in
bone mass at any give site.
(Smith) This effect increases in magnitude with advancing age, and thus the cited ratio is
only an approximation. The calculation of fracture risk should include multiple factors.
37. T F A “Dowager’s Hump” indicates thoracic compression fractures.
Usually, but not always. The “hump” can be a fibrous-fatty mass unrelated to kyphosis and osteoporosis.
38. T F
True.
Serum hypocalcemia will trigger the Parathyroid glands to release PTH which stimulates
osteoclast activity and bone resorption.
When the parathyroid glands perceive a hypocalcemic state, they mediate increased bone
resorption to restore calcium homeostasis in the blood stream … but bone homeostasis can
potentially suffer a net loss. The heart, skeletal muscles and nerves get their Ca supply first,
sometimes at the expense of the “bone bank”. [Analogy to pregnancy and the fetus getting
nutritional priority – and the old saying “Have a baby, lose a tooth”]
Conversely, serum hypercalcemia will trigger the thyroid to release calcitonin to stimulate
osteoblast activity. In this case the bones have a chance to restore their loss and return to a more
balanced homeostasis.
39.
True
TF
The diaphyses of long bones largely consist of cortical or compact bone.
40. T F
False
You read the nutrition information on a 6 oz. carton of yogurt and it says: “20% of Daily
Value of Calcium”. This is equivalent to 100 mg of Calcium.
41. T F
False
DEXA T-scores norm the patient’s data to their current age group.
42.
The recommended amount of calcium for my age / life stage is ______. I
regularly get that amount from my diet and / or supplements.
TF
43. T F
True
At least 55% of people over the age of 50 have osteoporosis
– NOF -- *** Lead-in to Meek’s Algorithm ***
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