OSTEOPOROSIS EXAM QUESTIONS AND
ANSWERS WITH RATIONALE GRADED A+
Questions 1–15: Definitions, Epidemiology, and Bone Biology
Question 1
What is the World Health Organization (WHO) definition of osteoporosis based on
bone mineral density (BMD) by DXA?
A. T-score between -1.0 and -2.5
B. T-score ≤ -2.5
C. T-score ≤ -1.0
D. Z-score ≤ -2.0
*Rationale: The WHO defines osteoporosis as BMD T-score ≤ -2.5 at the lumbar
spine, femoral neck, total hip, or distal radius (33% radius). Osteopenia (low bone
mass) is T-score between -1.0 and -2.5. Z-score compares to age-matched peers; a
Z-score ≤ -2.0 suggests secondary cause .*
Question 2
What is the approximate lifetime risk of osteoporotic fracture for a 50-year-old
woman?
A. 10%
B. 25%
C. 40-50%
D. 75%
*Rationale: The lifetime risk of any osteoporotic fracture (hip, spine, wrist,
humerus) for a 50-year-old woman is approximately 40-50% (similar to the risk of
coronary artery disease). For men, the risk is approximately 13-25% .*
,Question 3
Approximately how many women aged 50 years or older will sustain an
osteoporotic fracture in their remaining lifetime?
A. 1 in 10
B. 1 in 2 (50%)
C. 1 in 3 (33%)
D. 1 in 5 (20%)
*Rationale: Approximately 50% of women and 20-25% of men over age 50 will
experience an osteoporotic fracture. The most common fractures are vertebral
(spine), hip, and wrist (distal radius) .*
Question 4
What is the 1-year mortality rate after a hip fracture in older adults?
A. 5%
B. 10%
C. 20-30%
D. 50%
*Rationale: Hip fracture is associated with high mortality: approximately 20-30%
within 1 year. Many survivors lose independence and require long-term care. The
5-year mortality is even higher. Prompt surgical repair and secondary fracture
prevention are critical .*
Question 5
Which cell type is responsible for bone resorption?
A. Osteoblasts
B. Osteoclasts
C. Osteocytes
D. Chondrocytes
Rationale: Osteoclasts are multinucleated cells derived from
monocyte/macrophage lineage that resorb bone. Osteoblasts form bone.
,Osteocytes are mature osteoblasts embedded in bone matrix that sense
mechanical strain. Bisphosphonates and denosumab inhibit osteoclast activity .
Question 6
Which of the following is the most important regulator of osteoclast activity?
A. Parathyroid hormone (PTH)
B. Calcitonin
C. RANKL (receptor activator of nuclear factor kappa-B ligand)
D. Oestrogen
Rationale: RANKL (produced by osteoblasts and other cells) binds to RANK on
osteoclast precursors, promoting osteoclast differentiation, activation, and
survival. Denosumab is a monoclonal antibody against RANKL. Oestrogen and PTH
also modulate osteoclast activity but via RANKL .
Question 7
Which hormone deficiency is the most common cause of primary osteoporosis in
women?
A. Androgen deficiency
B. Oestrogen deficiency (postmenopausal)
C. Thyroid hormone deficiency
D. Cortisol deficiency
*Rationale: Postmenopausal osteoporosis is the most common form of primary
osteoporosis, caused by oestrogen deficiency, which increases RANKL expression
and osteoclast activity. Oestrogen also reduces osteoblast apoptosis (increases
bone formation). Menopause is associated with accelerated bone loss (2-5% per
year for 5-10 years) .*
Question 8
What is the difference between primary and secondary osteoporosis?
A. Primary osteoporosis is caused by medications; secondary is age-related
B. Primary osteoporosis only affects men
C. Primary osteoporosis is age-related (postmenopausal, senile) without an
, identifiable cause; secondary osteoporosis results from an underlying disease or
medication
D. There is no difference
Rationale: Primary osteoporosis includes postmenopausal (Type I) and age-related
senile (Type II). Secondary osteoporosis is caused by conditions (malabsorption,
hyperparathyroidism, hypogonadism, chronic kidney disease) or medications
(glucocorticoids, anticonvulsants, aromatase inhibitors) .
Question 9
What is the most common type of osteoporotic fracture?
A. Hip fracture
B. Vertebral (spine) compression fracture
C. Wrist (Colles) fracture
D. Humeral fracture
Rationale: Vertebral compression fractures are the most common osteoporotic
fractures, though many are asymptomatic (incidental findings on imaging). Each
vertebral fracture increases the risk of subsequent fractures (both vertebral and
non-vertebral) .
Question 10
What is the gender difference in osteoporosis prevalence?
A. More common in men
B. More common in women (approximately 2-3:1)
C. Equal prevalence
D. Only affects women
Rationale: Osteoporosis affects approximately 1 in 3 women and 1 in 5 men over
age 50. Women have lower peak bone mass and lose bone more rapidly after
menopause. However, men with hip fractures have higher mortality than women .
Question 11
At what age does peak bone mass typically occur?
ANSWERS WITH RATIONALE GRADED A+
Questions 1–15: Definitions, Epidemiology, and Bone Biology
Question 1
What is the World Health Organization (WHO) definition of osteoporosis based on
bone mineral density (BMD) by DXA?
A. T-score between -1.0 and -2.5
B. T-score ≤ -2.5
C. T-score ≤ -1.0
D. Z-score ≤ -2.0
*Rationale: The WHO defines osteoporosis as BMD T-score ≤ -2.5 at the lumbar
spine, femoral neck, total hip, or distal radius (33% radius). Osteopenia (low bone
mass) is T-score between -1.0 and -2.5. Z-score compares to age-matched peers; a
Z-score ≤ -2.0 suggests secondary cause .*
Question 2
What is the approximate lifetime risk of osteoporotic fracture for a 50-year-old
woman?
A. 10%
B. 25%
C. 40-50%
D. 75%
*Rationale: The lifetime risk of any osteoporotic fracture (hip, spine, wrist,
humerus) for a 50-year-old woman is approximately 40-50% (similar to the risk of
coronary artery disease). For men, the risk is approximately 13-25% .*
,Question 3
Approximately how many women aged 50 years or older will sustain an
osteoporotic fracture in their remaining lifetime?
A. 1 in 10
B. 1 in 2 (50%)
C. 1 in 3 (33%)
D. 1 in 5 (20%)
*Rationale: Approximately 50% of women and 20-25% of men over age 50 will
experience an osteoporotic fracture. The most common fractures are vertebral
(spine), hip, and wrist (distal radius) .*
Question 4
What is the 1-year mortality rate after a hip fracture in older adults?
A. 5%
B. 10%
C. 20-30%
D. 50%
*Rationale: Hip fracture is associated with high mortality: approximately 20-30%
within 1 year. Many survivors lose independence and require long-term care. The
5-year mortality is even higher. Prompt surgical repair and secondary fracture
prevention are critical .*
Question 5
Which cell type is responsible for bone resorption?
A. Osteoblasts
B. Osteoclasts
C. Osteocytes
D. Chondrocytes
Rationale: Osteoclasts are multinucleated cells derived from
monocyte/macrophage lineage that resorb bone. Osteoblasts form bone.
,Osteocytes are mature osteoblasts embedded in bone matrix that sense
mechanical strain. Bisphosphonates and denosumab inhibit osteoclast activity .
Question 6
Which of the following is the most important regulator of osteoclast activity?
A. Parathyroid hormone (PTH)
B. Calcitonin
C. RANKL (receptor activator of nuclear factor kappa-B ligand)
D. Oestrogen
Rationale: RANKL (produced by osteoblasts and other cells) binds to RANK on
osteoclast precursors, promoting osteoclast differentiation, activation, and
survival. Denosumab is a monoclonal antibody against RANKL. Oestrogen and PTH
also modulate osteoclast activity but via RANKL .
Question 7
Which hormone deficiency is the most common cause of primary osteoporosis in
women?
A. Androgen deficiency
B. Oestrogen deficiency (postmenopausal)
C. Thyroid hormone deficiency
D. Cortisol deficiency
*Rationale: Postmenopausal osteoporosis is the most common form of primary
osteoporosis, caused by oestrogen deficiency, which increases RANKL expression
and osteoclast activity. Oestrogen also reduces osteoblast apoptosis (increases
bone formation). Menopause is associated with accelerated bone loss (2-5% per
year for 5-10 years) .*
Question 8
What is the difference between primary and secondary osteoporosis?
A. Primary osteoporosis is caused by medications; secondary is age-related
B. Primary osteoporosis only affects men
C. Primary osteoporosis is age-related (postmenopausal, senile) without an
, identifiable cause; secondary osteoporosis results from an underlying disease or
medication
D. There is no difference
Rationale: Primary osteoporosis includes postmenopausal (Type I) and age-related
senile (Type II). Secondary osteoporosis is caused by conditions (malabsorption,
hyperparathyroidism, hypogonadism, chronic kidney disease) or medications
(glucocorticoids, anticonvulsants, aromatase inhibitors) .
Question 9
What is the most common type of osteoporotic fracture?
A. Hip fracture
B. Vertebral (spine) compression fracture
C. Wrist (Colles) fracture
D. Humeral fracture
Rationale: Vertebral compression fractures are the most common osteoporotic
fractures, though many are asymptomatic (incidental findings on imaging). Each
vertebral fracture increases the risk of subsequent fractures (both vertebral and
non-vertebral) .
Question 10
What is the gender difference in osteoporosis prevalence?
A. More common in men
B. More common in women (approximately 2-3:1)
C. Equal prevalence
D. Only affects women
Rationale: Osteoporosis affects approximately 1 in 3 women and 1 in 5 men over
age 50. Women have lower peak bone mass and lose bone more rapidly after
menopause. However, men with hip fractures have higher mortality than women .
Question 11
At what age does peak bone mass typically occur?
