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1. All of the following are true concerning vertebral fractures EXCEPT [1]:

   A. They are the most common complication of osteoporosis
   B. Symptoms include pain and limitation of motion
   C. Signs include shrinkage in height
   D. One vertebral fracture increases risk is not a risk factor for new vertebral fractures
   E. Alendronate (Fosamax®), a bisphosphonate, prevents new fractures and aids healing

2. Which ONE of the following statements concerning bone metabolism is true [2] ?

   A. Heat labile Alkaline Phosphatase is primarily a marker of osteoblastic activity
   B. Serum Osteocalcin is a marker for bone formation
   C. Urinary hydroxyproline levels are markers for new bone (collagen) synthesis
   D. Circulating levels of 25-hydroxyvitamin D are similar to those of 1,25-dihydroxyvitamin D
   E. Serum calcium levels need not be corrected for circulating albumin levels

3. All of the following are stimulators of Osteoclasts EXCEPT [3]:

   A. Macrophage colony stimulating factor
   B. Parathyroid Hormone
   C. Interleukins 1 and 6
   D. Tumor necrosis factor alpha (TNFa)
   E. Estrogens

4. All of the following are true concerning osteogenesis imperfecta EXCEPT [4]:

   A. Autosomal dominant disease characterized by abnormal collagen
   B. Brittle bones are characteristic of the disease
   C. Pamidronate (intravenous bisphosphonate) improves fractures and mobility in all patients
   D. Hundreds of fractures occur during lifetime, with much deformity
   E. Multiple fractures can occur in utero and may lead to fetal death

5. Which ONE of the following statements concerning hereditary rickets is TRUE [5] ?

   A. Rickets is Vitamin D (Vit D) deficiency of any etiology after closure of epiphysial plate
   B. Pseudovitamin D-deficiency (Type 1) is due to vitamin D transport defects
   C. Reduction in Vitamin D leads to inability to utilize calcium properly during bone development
   D. Hereditary rickets is most often caused by deficiency in conversion of 25-hydroxyvitamin D to 1,25-hydroxyvitamin D
   E. Tall stature but with weak, deformable bones are characteristic

6. All of the following have been shown to reduce fractures in osteoporotic women EXCEPT [6]:

   A. Hydroxymethylgluteryl Coenzyme A (HMG-CoA) Reductase Inhibitors
   B. Parathyroid Hormone
   C. Alendronate
   D. Raloxifene
   E. Calcium carbonate supplemention alone

7. All of the following are characteristics of the bone disease associated with hyperparathyroidism EXCEPT [7]:

   A. "Punched out" lesions on skeletal radiographs
   B. Pathologic Fractures
   a. Demineralization and fibrosis - especially in cortical bone (such as distal radius) C. Osteitis fibrosa cystica
   D. Chondrocalcinosis (~10% of patients)
   E. Pseudogout

8. All of the following are characteristics of hypertrophic osteoarthropathy EXCEPT [8]:

   A. Abnormal proliferation of skin and osseous structures at distal extremities
   B. Abnormalities in collagen sequence are usually found
   C. Clubbing is very prominant
   D. Periostosis of the tubular bones with synovial effusions
   E. Underlying cardiac, pulmonary, or hepatic disease are most commonly found

9. All of the following are common underlying causes of pathologic fractures EXCEPT [9]:

   A. Stress Fractures
   B. Hyperparathyroidism
   C. Multiple Myeloma
   D. Osteoporosis
   E. Metastatic Prostate Cancer

10. All of the following are inhibitors of Osteoclasts EXCEPT []:

    A. Calcium
    B. Transforming growth factor ß (TGFß)
    C. Sodium Flouride
    D. Calcitonin
    E. Bisphosphonates

Answers

1. D
2. B
3. E
4. C
5. C
6. E
7. A
8. A
9. C