CCD EXAM QUESTIONS AND ANSWERS
RATED A.
If a patient presents for follow-up and the baseline study was not
performed on any scanner operated by the provider then no
_______________ statements regarding changes in BMD can be made.
quantitative
The _________________________ is the preferred skeletal site for
monitoring changes as it is most responsive to therapy.
PA spine
Monitoring BMD of forearm is useful in ____________________.
hyperparathyroidism
Intervals between BMD testing should be determined according to each
patient's _____________ ________________.
clinical status
Typically ___ year intervals between BMD testing is appropriate after
treatment initiation or change in therapy.
1
Fracture Risk Reduction With Treatment _______________ that Expected
from BMD Gain Alone
Exceeds
DXA Nomenclature
DXA
T-score
Z-score
VFA
BMD reported in 3 decimal digits (0.927 g/cm2)
,Use a _______________ to measure height.
stadiometer
Use __________________ in children, premenopausal women, and men
younger than age 50
Z-scores
Lumbar spine DXA ________________ BMD in SCI, and does not predict
risk of subsequent fractures in lower extremities
overestimates
T-scores should be calculated using a uniform Caucasian (non-race
adjusted) ____________ normative database for all transgender
individuals of all ethnic groups; we recommend using a T-score of <-2.5 or
less for diagnosis of osteoporosis in all TGNC individuals age 50 years or
older, regardless of hormonal status
female
In transgender/non-conforming individuals, the normative database that
matches the ______ recorded at birth should be used
sex
____________________________ should be considered in patients prior to
elective orthopaedic and spine surgery
Bone health assessment
Routine DXA scans should include PA lumbar spine and hip
◦ Forearm DXA should be considered in patients having upper limb surgery
◦ VFA should be considered in patients having spine surgery
Pharmacologic treatment indicated if FRAX risk of MOF is greater than or
equal to ____.
20%
Pharmacologic treatment indicated if FRAX risk of hip fracture is greater
than or equal to ____.
,3%
Without the _______________, a DXA report cannot be trusted
images
Spine phantom BMD measurement is performed at least once
_____________ to document stability of DXA performance over time.
weekly
Clinical risk factors are not a substitute for ________ testing.
BMD
In patients with primary bone disease, or at risk for a secondary bone
disease, a DXA should be performed when the patient may benefit from
___________________ to decrease their elevated risk of a clinically
significant fracture, and the DXA results will influence that management.
interventions
Pediatric Indications for BMD Testing
2+ long bone fractures in children < 10 yo or 3+ long bone fractures in
children > 10 yo) or any vertebral fracture
Underlying or co-morbid diseases or treatments that predispose to low BMD
In children, adolescents, premenopausal women and healthy men under
age 50, the diagnosis of osteoporosis _________________ be made on the
basis of densitometric criteria alone.
should not
All adults with _________________________ resulting in permanent motor
or sensory dysfunction should have a DXA scan of the total hip, proximal
tibia and distal femur, as soon as medically stable
spinal cord injury
Baseline DXA in transgender individuals is indicated if history of
gonadectomy or _____________________.
, hypogonadism
Contraindicatons to Central DXA
Pregnancy
Recent contrast within 72 hours
Extensive orthopedic instrumentation
Body weight greater than table limit (just measure forearm)
Recommended testing for secondary causes include...
Vit D
Calcium
PTH
Creatinine
TSH
Testosterone
N-Telopeptide (NTX) & C-Telopeptide (CTX) & TRAP5b are markers of bone
________________.
resorption
Bone specific alkaline phosphatase (BSAP), Osteocalcin, and Procollagen
type 1 Nterminal propeptide (P1NP) are markers of bone
_________________.
formation
Early Changes in Bone Turnover Markers are Associated with Long-term
Changes in __________.
BMD
_________________Therapy (Teriparatide) Increases Both Formation and
Resorption Markers
Anabolic
CTX and/or P1NP can be used to evaluate patient adherence and drug
responses to ___________________ agents
RATED A.
If a patient presents for follow-up and the baseline study was not
performed on any scanner operated by the provider then no
_______________ statements regarding changes in BMD can be made.
quantitative
The _________________________ is the preferred skeletal site for
monitoring changes as it is most responsive to therapy.
PA spine
Monitoring BMD of forearm is useful in ____________________.
hyperparathyroidism
Intervals between BMD testing should be determined according to each
patient's _____________ ________________.
clinical status
Typically ___ year intervals between BMD testing is appropriate after
treatment initiation or change in therapy.
1
Fracture Risk Reduction With Treatment _______________ that Expected
from BMD Gain Alone
Exceeds
DXA Nomenclature
DXA
T-score
Z-score
VFA
BMD reported in 3 decimal digits (0.927 g/cm2)
,Use a _______________ to measure height.
stadiometer
Use __________________ in children, premenopausal women, and men
younger than age 50
Z-scores
Lumbar spine DXA ________________ BMD in SCI, and does not predict
risk of subsequent fractures in lower extremities
overestimates
T-scores should be calculated using a uniform Caucasian (non-race
adjusted) ____________ normative database for all transgender
individuals of all ethnic groups; we recommend using a T-score of <-2.5 or
less for diagnosis of osteoporosis in all TGNC individuals age 50 years or
older, regardless of hormonal status
female
In transgender/non-conforming individuals, the normative database that
matches the ______ recorded at birth should be used
sex
____________________________ should be considered in patients prior to
elective orthopaedic and spine surgery
Bone health assessment
Routine DXA scans should include PA lumbar spine and hip
◦ Forearm DXA should be considered in patients having upper limb surgery
◦ VFA should be considered in patients having spine surgery
Pharmacologic treatment indicated if FRAX risk of MOF is greater than or
equal to ____.
20%
Pharmacologic treatment indicated if FRAX risk of hip fracture is greater
than or equal to ____.
,3%
Without the _______________, a DXA report cannot be trusted
images
Spine phantom BMD measurement is performed at least once
_____________ to document stability of DXA performance over time.
weekly
Clinical risk factors are not a substitute for ________ testing.
BMD
In patients with primary bone disease, or at risk for a secondary bone
disease, a DXA should be performed when the patient may benefit from
___________________ to decrease their elevated risk of a clinically
significant fracture, and the DXA results will influence that management.
interventions
Pediatric Indications for BMD Testing
2+ long bone fractures in children < 10 yo or 3+ long bone fractures in
children > 10 yo) or any vertebral fracture
Underlying or co-morbid diseases or treatments that predispose to low BMD
In children, adolescents, premenopausal women and healthy men under
age 50, the diagnosis of osteoporosis _________________ be made on the
basis of densitometric criteria alone.
should not
All adults with _________________________ resulting in permanent motor
or sensory dysfunction should have a DXA scan of the total hip, proximal
tibia and distal femur, as soon as medically stable
spinal cord injury
Baseline DXA in transgender individuals is indicated if history of
gonadectomy or _____________________.
, hypogonadism
Contraindicatons to Central DXA
Pregnancy
Recent contrast within 72 hours
Extensive orthopedic instrumentation
Body weight greater than table limit (just measure forearm)
Recommended testing for secondary causes include...
Vit D
Calcium
PTH
Creatinine
TSH
Testosterone
N-Telopeptide (NTX) & C-Telopeptide (CTX) & TRAP5b are markers of bone
________________.
resorption
Bone specific alkaline phosphatase (BSAP), Osteocalcin, and Procollagen
type 1 Nterminal propeptide (P1NP) are markers of bone
_________________.
formation
Early Changes in Bone Turnover Markers are Associated with Long-term
Changes in __________.
BMD
_________________Therapy (Teriparatide) Increases Both Formation and
Resorption Markers
Anabolic
CTX and/or P1NP can be used to evaluate patient adherence and drug
responses to ___________________ agents
