Question 1

A 50-year-old white woman who is experiencing menopause asks the primary care NP what she can do to prevent osteoporosis.She has a negative family history and no risk factors.The NP should counsel her to:

Accepted Answer

Postmenopausal women should consume 1200 mg of calcium and at least 1000 U of vitamin D each day.Bisphosphonate therapy should be considered for persons with known risk factors.Bone density testing is indicated for women with risk factors and then routinely after age 65.Patients should be encouraged to engage in high-impact sports if possible to improve bone density.

Question 2

A 60-year-old woman is in the clinic for an annual well-woman examination.She has been taking alendronate (Fosamax)10 mg daily for 4 years.Her last bone density test yielded a T-score of 2.0.Her urine NTx level today is 22.She walks daily.Her fracture risk is low.The primary care NP should recommend that she:

Accepted Answer

The American Association of Clinical Endocrinologists recommends patients have a "drug holiday" after 4 to 5 years of bisphosphonate treatment if osteoporosis is mild and the fracture risk is low.The other options are all viable treatment regimens but are not appropriate in this case.

Question 3

A 60-year-old woman has a central dual-energy x-ray absorptiometry with a T-score of 1.9.A health history reveals no risk factors for osteoporosis.The primary care NP should:

Accepted Answer

This woman's T-score is less than 2.5 and indicates osteoporosis.She should begin treatment with a bisphosphonate.Increasing physical activity and taking supplemental calcium and vitamin D are indicated as well but only as part of a medication regimen.Calcitonin is not a first-line medication.

Question 4

A 70-year-old patient who has a high fracture risk has been taking alendronate (Fosamax)and calcium for 6 months.The primary care NP orders a urine NTx level,which is 42.The NP should discontinue the alendronate and prescribe:

Accepted Answer

Teriparatide is used in patients with a high fracture risk or in whom bisphosphonate therapy has failed.Raloxifene and ibandronate are second-line treatments for patients with usual fracture risks.Calcitonin is a last-line treatment.

Question 5

A 50-year-old woman with osteopenia will begin taking raloxifene (Evista).When counseling this patient about this drug regimen,the primary care NP should tell her to:

Accepted Answer

Raloxifene is a selective estrogen receptor modulator,and it carries a risk of venous thromboembolism.Patients should be encouraged to avoid immobilization.The other instructions are part of medication teaching about bisphosphonates.

Question 6

A 60-year-old female patient has begun taking a daily bisphosphonate to prevent osteoporosis and complains of gastrointestinal (GI)upset and dyspepsia.The primary care NP's initial response should be to:

Accepted Answer

Oral bisphosphonates must be taken on an empty stomach,and the patient must remain upright and not eat or drink anything for 30 to 60 minutes.GI upset and dyspepsia are frequent and can be minimized with correct administration.A PPI is not indicated.IV bisphosphonates may be indicated if the patient is unable to tolerate the oral drug after correct administration is confirmed.Bisphosphonates should not be taken with food.

Question 7

A 55-year-old woman who experienced menopause at age 50 years undergoes central dual-energy x-ray absorptiometry and has a T-score greater than 2.5.The patient weighs 130 lb and has a body mass index of 22.She sits at a computer all day at work.The primary care nurse practitioner (NP)caring for this patient should:

Accepted Answer

The NP should counsel the patient about diet and exercise.Women who are at least 5 years postmenopausal or who have several risk factors should have bone density testing.Osteoporosis is defined as a T-score of less than 2.5,and treatment is indicated for women with T-scores that are 2 or more standard deviations below the normal premenopausal level.It is not necessary to initiate treatment at this time.

Question 8

A patient who has several risk factors for osteoporosis has a bone density test that indicates osteopenia.The primary care NP plans to prescribe a bisphosphonate.Before initiating treatment,the NP should:

Accepted Answer

Patients must have adequate nutrition,calcium,and vitamin D.Hypocalcemia and vitamin D deficiency must be corrected before therapy is initiated.An upper GI x-ray is indicated only if the patient is symptomatic.Patients at risk for fracture should not take PPIs.Calcium and vitamin D supplements should be given with bisphosphonate therapy; however,the first action is to evaluate current serum levels.

Quiz 39: Osteoporosis Treatment

A 50-year-old white woman who is experiencing menopause asks the primary care NP what she can do to prevent osteoporosis.She has a negative family history and no risk factors.The NP should counsel her to:

A 60-year-old woman has a central dual-energy x-ray absorptiometry with a T-score of 1.9.A health history reveals no risk factors for osteoporosis.The primary care NP should:

A 70-year-old patient who has a high fracture risk has been taking alendronate (Fosamax) and calcium for 6 months.The primary care NP orders a urine NTx level,which is 42.The NP should discontinue the alendronate and prescribe:

A 50-year-old woman with osteopenia will begin taking raloxifene (Evista) .When counseling this patient about this drug regimen,the primary care NP should tell her to:

A 60-year-old female patient has begun taking a daily bisphosphonate to prevent osteoporosis and complains of gastrointestinal (GI) upset and dyspepsia.The primary care NP's initial response should be to:

A patient who has several risk factors for osteoporosis has a bone density test that indicates osteopenia.The primary care NP plans to prescribe a bisphosphonate.Before initiating treatment,the NP should: