NAMS COMPREHENSIVE CERTIFICATION
EVALUATION VERIFIED QUESTIONS AND
FULL SOLUTIONS
●● At what age does the North American Menopause Society
recommend routine DXA screening for osteoporosis in postmenopausal
women?
Answer: Age 65 years or older is the threshold for routine DXA
screening in postmenopausal women, or younger if risk factors are
present.
●● How is osteopenia defined by T-score on DXA?
Answer: A T-score between -1.0 and -2.5 defines osteopenia.
●● What is the primary effect of menopause on bone health?
Answer: Estrogen deficiency after menopause accelerates bone
resorption, leading to rapid bone loss.
●● List three major risk factors for low bone mass and fracture in
postmenopausal women.
Answer: Advanced age, prior fragility fracture, and glucocorticoid use
are major risk factors.
,●● Which tool is commonly used to estimate 10-year fracture risk in
clinical practice?
Answer: FRAX (Fracture Risk Assessment Tool) is commonly used to
estimate 10-year fracture risk.
●● What is the threshold 10-year risk of hip fracture or major
osteoporotic fracture that indicates pharmacologic therapy according to
FRAX?
Answer: A 10-year hip fracture risk ≥3% or major osteoporotic fracture
risk ≥20% indicates pharmacologic therapy per FRAX.
●● Name two first-line pharmacologic therapies for osteoporosis in
postmenopausal women.
Answer: Bisphosphonates (e.g., alendronate, risedronate, zoledronic
acid) and denosumab are first-line therapies.
●● What is the role of hormone therapy in the prevention of
postmenopausal osteoporosis?
Answer: Hormone therapy is effective for prevention of bone loss in
early postmenopausal women at risk, but not first-line for osteoporosis
treatment.
●● Which pharmacologic agent is preferred for women at very high risk
of fracture?
, Answer: Anabolic agents (e.g., teriparatide, abaloparatide,
romosozumab) are preferred for women at very high fracture risk.
●● What are the main contraindications to menopausal hormone
therapy?
Answer: Active or recent breast cancer, unexplained vaginal bleeding,
active thromboembolic disease, and liver dysfunction are main
contraindications to hormone therapy.
●● Why is progestogen added to estrogen therapy in women with an
intact uterus?
Answer: Progestogen is needed with estrogen therapy in women with a
uterus to prevent endometrial hyperplasia/cancer.
●● Compare the risks of oral versus transdermal estrogen therapy.
Answer: Transdermal estrogen has a lower risk of venous
thromboembolism and stroke compared to oral estrogen.
●● What is the recommended duration of systemic hormone therapy for
vasomotor symptoms?
Answer: The shortest duration necessary to control symptoms, typically
reassessed annually; often 3-5 years for systemic therapy.
●● Describe the difference between continuous and sequential hormone
therapy regimens.
EVALUATION VERIFIED QUESTIONS AND
FULL SOLUTIONS
●● At what age does the North American Menopause Society
recommend routine DXA screening for osteoporosis in postmenopausal
women?
Answer: Age 65 years or older is the threshold for routine DXA
screening in postmenopausal women, or younger if risk factors are
present.
●● How is osteopenia defined by T-score on DXA?
Answer: A T-score between -1.0 and -2.5 defines osteopenia.
●● What is the primary effect of menopause on bone health?
Answer: Estrogen deficiency after menopause accelerates bone
resorption, leading to rapid bone loss.
●● List three major risk factors for low bone mass and fracture in
postmenopausal women.
Answer: Advanced age, prior fragility fracture, and glucocorticoid use
are major risk factors.
,●● Which tool is commonly used to estimate 10-year fracture risk in
clinical practice?
Answer: FRAX (Fracture Risk Assessment Tool) is commonly used to
estimate 10-year fracture risk.
●● What is the threshold 10-year risk of hip fracture or major
osteoporotic fracture that indicates pharmacologic therapy according to
FRAX?
Answer: A 10-year hip fracture risk ≥3% or major osteoporotic fracture
risk ≥20% indicates pharmacologic therapy per FRAX.
●● Name two first-line pharmacologic therapies for osteoporosis in
postmenopausal women.
Answer: Bisphosphonates (e.g., alendronate, risedronate, zoledronic
acid) and denosumab are first-line therapies.
●● What is the role of hormone therapy in the prevention of
postmenopausal osteoporosis?
Answer: Hormone therapy is effective for prevention of bone loss in
early postmenopausal women at risk, but not first-line for osteoporosis
treatment.
●● Which pharmacologic agent is preferred for women at very high risk
of fracture?
, Answer: Anabolic agents (e.g., teriparatide, abaloparatide,
romosozumab) are preferred for women at very high fracture risk.
●● What are the main contraindications to menopausal hormone
therapy?
Answer: Active or recent breast cancer, unexplained vaginal bleeding,
active thromboembolic disease, and liver dysfunction are main
contraindications to hormone therapy.
●● Why is progestogen added to estrogen therapy in women with an
intact uterus?
Answer: Progestogen is needed with estrogen therapy in women with a
uterus to prevent endometrial hyperplasia/cancer.
●● Compare the risks of oral versus transdermal estrogen therapy.
Answer: Transdermal estrogen has a lower risk of venous
thromboembolism and stroke compared to oral estrogen.
●● What is the recommended duration of systemic hormone therapy for
vasomotor symptoms?
Answer: The shortest duration necessary to control symptoms, typically
reassessed annually; often 3-5 years for systemic therapy.
●● Describe the difference between continuous and sequential hormone
therapy regimens.
