ISCD Exam and Solutions.
Total body scan analysis correct answers WHO T-score classification does not apply
cancellous bone (spongy bone) correct answers Spine, ultradistal radius, calcaneus
Lost first in post menopausal women
cortical bone correct answers compact bone — femoral neck, 1/3 radius, total body
Affected first by hyperparathyroisism, esp wrist
Measurement sites in kids correct answers 4-16 total body or body minus head
> 16 hip & spine
Mixed bone correct answers Total hip, trochanter, phalanges
Osteoporosis correct answers Fragility fracture (standing height or less)
Hip fracture
Vertebral, proximal humerus, or pelvis fx + osteopenia
Incidental vertebral fox
BMD </= -2.5
FRAX >/= 3 or 20
T-score correct answers BMD patient - BMD young normal mean reference / SD young normal
mean reference
Z-score correct answers BMD patient - BMD age matched mean reference / SD age matched
mean reference
Normal BMD child correct answers Z-score > -2
T-score calculation database correct answers Hip: NHANES female Caucasian
Spine: manufacturer female Caucasian
Race adjustment and osteoporosis correct answers T-score NO
Z-score YES
Osteoporosis in kids correct answers Low BMD AND fracture
Fractures: vertebral, single LEs, two UEs
Non DXA T-scores correct answers QCT hip and femoral neck only allowed
How much bone strength is predicted by BMD? correct answers 60-80%
absolute risk correct answers Number of people who develop a disease/number of people at risk
Relative Risk (RR) correct answers Ratio of absolute risk in 2 groups
, Ex. Absolute risk of fracture in smokers / absolute risk in nonsmokers = relative risk of fracture
in smokers
Risk of vertebral fracture for future vertebral fractures correct answers 20% 1-3 yrs
Risk of contralateral hip fracture after hip fx correct answers 29% in 5 yrs
5 year risk of fracture after any fx correct answers Forearm: 15% males, 20% females
Vertebral: 18% males, 33% females
Risk factors for fracture independent of BMD correct answers Low BMI
Prior fx
Family h/o hip fx
Current smoker
Steroids (ever — 5mg per day > 3 months)
EtOH > 2
RA
FRAX age correct answers 40-90
NOF criteria for using FRAX correct answers Untreated postmenopausal woman (or man > 50)
T-score -1 to -2.5
No prior hip or vertebral fx
Evaluable hip
'Untreated' per FRAX correct answers No bisphosphonate x 2 years (up to 2 mos oral ok)
No other tx incl calcitonin, SERM, HR x 1 year
FRAX adjustment for hip/spine discordance correct answers For every rounded T-score
difference of 1 unit, adjust risk of major osteoporotic fx up or down by 10%
ex. FN T-score -1.5, lS -3.5
Increase MOF by 20% (ex. MOF risk is 18%, add 3.6)
FRAX adjustment for steroid dose correct answers Low dose (<2.5mg): MOF -20%, Hip -35%
Medium (2.5 to 7.5): no adjustment
High (>/= 7.5mg): MOF +15%, Hip +20%
TBS correct answers < 1.2 degraded
1.2 - 1.3 partially degraded
> 1.3 intact
FRAX considerations correct answers Can check RA box for type 2 DM or MS
Remove parental risk if their fax was > 80
Benefits of GARVAN fracture risk calculator correct answers Includes all fractures
Includes all fractures not just hip spine humerus wrist
Total body scan analysis correct answers WHO T-score classification does not apply
cancellous bone (spongy bone) correct answers Spine, ultradistal radius, calcaneus
Lost first in post menopausal women
cortical bone correct answers compact bone — femoral neck, 1/3 radius, total body
Affected first by hyperparathyroisism, esp wrist
Measurement sites in kids correct answers 4-16 total body or body minus head
> 16 hip & spine
Mixed bone correct answers Total hip, trochanter, phalanges
Osteoporosis correct answers Fragility fracture (standing height or less)
Hip fracture
Vertebral, proximal humerus, or pelvis fx + osteopenia
Incidental vertebral fox
BMD </= -2.5
FRAX >/= 3 or 20
T-score correct answers BMD patient - BMD young normal mean reference / SD young normal
mean reference
Z-score correct answers BMD patient - BMD age matched mean reference / SD age matched
mean reference
Normal BMD child correct answers Z-score > -2
T-score calculation database correct answers Hip: NHANES female Caucasian
Spine: manufacturer female Caucasian
Race adjustment and osteoporosis correct answers T-score NO
Z-score YES
Osteoporosis in kids correct answers Low BMD AND fracture
Fractures: vertebral, single LEs, two UEs
Non DXA T-scores correct answers QCT hip and femoral neck only allowed
How much bone strength is predicted by BMD? correct answers 60-80%
absolute risk correct answers Number of people who develop a disease/number of people at risk
Relative Risk (RR) correct answers Ratio of absolute risk in 2 groups
, Ex. Absolute risk of fracture in smokers / absolute risk in nonsmokers = relative risk of fracture
in smokers
Risk of vertebral fracture for future vertebral fractures correct answers 20% 1-3 yrs
Risk of contralateral hip fracture after hip fx correct answers 29% in 5 yrs
5 year risk of fracture after any fx correct answers Forearm: 15% males, 20% females
Vertebral: 18% males, 33% females
Risk factors for fracture independent of BMD correct answers Low BMI
Prior fx
Family h/o hip fx
Current smoker
Steroids (ever — 5mg per day > 3 months)
EtOH > 2
RA
FRAX age correct answers 40-90
NOF criteria for using FRAX correct answers Untreated postmenopausal woman (or man > 50)
T-score -1 to -2.5
No prior hip or vertebral fx
Evaluable hip
'Untreated' per FRAX correct answers No bisphosphonate x 2 years (up to 2 mos oral ok)
No other tx incl calcitonin, SERM, HR x 1 year
FRAX adjustment for hip/spine discordance correct answers For every rounded T-score
difference of 1 unit, adjust risk of major osteoporotic fx up or down by 10%
ex. FN T-score -1.5, lS -3.5
Increase MOF by 20% (ex. MOF risk is 18%, add 3.6)
FRAX adjustment for steroid dose correct answers Low dose (<2.5mg): MOF -20%, Hip -35%
Medium (2.5 to 7.5): no adjustment
High (>/= 7.5mg): MOF +15%, Hip +20%
TBS correct answers < 1.2 degraded
1.2 - 1.3 partially degraded
> 1.3 intact
FRAX considerations correct answers Can check RA box for type 2 DM or MS
Remove parental risk if their fax was > 80
Benefits of GARVAN fracture risk calculator correct answers Includes all fractures
Includes all fractures not just hip spine humerus wrist
