False (Aisenberry) While cancellous bone is the most metabolically active and the first toFalsePT 8390 Case Management IIOsteoporosis Quiz, not for a grade1. T F Although osteoporotic bones are more porous than healthy bone, the bone that is present is well calcified.True (Salter) This is in contrast to Osteomalacia “Rickets” in which the bone becomes demineralized and soft.2. TF Ovolacto Vegetarian diet increases the risk of osteoporosis.False (Marsh) A study of 1600 women who at age 80 had been ovolacto vegetarians for 20 years showed their bone loss to be 18%compared to omnivores who lost 35%4. TF A diet high in animal protein decreases the risk of osteoporosis.False (Marsh; Calvo; Draper; Germano) Calcium homeostasis may be upset when high levels of phosphorous (in this case from protein) is taken in. A Ca:P ratio greater than 1:2 causes bone loss in animal studies. Raising protein intake from 50g to 150g can double the amount of calcium excreted.5. T F Over half of all girls under 15 don’t get enough calcium in their diet.True (Notelovitz)6. T F Japanese live with a much lower bone density than Americans but sustain a lower rate of osteoporotic fracturesTrue (Germano) It is postulated that a diet high in soy, sea vegetables, and moderate proteinintake may be a factor. Dairy products are commonly avoided.7. T F Northern European have higher dairy consumption and lower rates of osteoporotic fractures.False (Germano) Northern Europeans have among the highest osteoporotic fracture rate. In Scandinavian countries it has been recently speculated that the average diet is too high in Vitamin A (from fish oils and as an additive) and that this promotes increased rates of bone loss.8. T F By ethnic group the people who have the highest rate of lactose intolerance are African Americans, followed by Hispanics, followed by Whites.True (Notelovitz) Respectively the rates are 80%, 51%, and 21%9. T F Yogurt has less lactose than milk or cheese.False (Notelovitz) Cheese has nearly all the lactose removed as whey10. T F The oxalic acid present in green leafy vegetables such as spinach, beet greens, and rhubarb increases the availability of the high levels of calcium that they contain.False Oxalic acid binds the calcium and makes it less available. Examples of green vegetable high in calcium that do NOT have significant levels of oxalic acid are: brocolli (90mg Cal/1/2 cup), kale(100), collards(150), turnip greens(225), and seaweeds(500-2000).11. T F Very strenuous and prolonged physical training can result in bone loss for women, but not for men.False (Hetland; Hetland) Bone loss can occur in both men and women. Female triad: amenorrhea, anorexia, stress fracture12. T F DEXA bone density scans may rate a falsely high bone mineral density (BMD) score in patients with OA.1True (Notelovitz) Bone spurs and calcium nodules give the appearance of higher density i.e. a false negative. Scoliosis and existing compression fractures will similarly skew the results.13. T F Microscopic progressive compression fractures in the vertebrae manifest as continuous chronic pain.False and True. Compression fracures may be the undiagnosed cause of chronic back pain. However, vertebral compression fractures may be symptomatic or asympromatic.Vertebral destruction can progress without pain for extended periods, punctuated by acute episodes.14. T F Radiation exposure from a DEXA is greater than that received from dental X rays.False (Notelovitz) DEXA exposure is 2-4 mrem, while a dental X ray is 300 mrem. CXR = 2515. T F Birth Control Pills increase the risk of bone loss.False (Notelovitz p.61) Estrogen and progesterone enhance bone density.16. T F Before rarefaction would be evident on a standard X ray, at least one third of the BMD would already have been lost.True17. T F Low levels of sex hormones can cause osteoporosis in women and men.True For women, estrogen levels drop with menopause. For men low testosterone, also called hypogonadism,can be the results of genetics or or the aging process.18. T F The metaphyses of long bones largely consist of cancellous or trabecular boneTrue19. T F High impact exercise is useful both in the prevention and treatment of osteoporosis.False (Meeks) Numerous studies indicate the benefit of high impact exercise for prevention, however with pre existing osteoporosis, the risk of fracture is too great to justify potential benefits.20. T F Patients on bed rest lose BMD at the rate of 1% per week, but re-cover it only at a rate of 1% per month.True (Krolner)21. T F Postmenopausal bone loss can be 2-8% per year for the first 5 years, while non hormonal age-related loss is 0.5% per year.True (Dowd) (Secondary = steroid induced, etc.)(the most rapid postmenopausal loss occurs in the first5-7 years)22. T F The National Osteoporosis Foundation recommends a lifting restriction of 20# for people with osteoporosis.True However if vertebral deformity is present, the recommended lifting limitis 10# (Vaughan).23. T F Pain radiating around the chest wall from a wedge compression fracture is due to nerve root compression.False (McClung) The cause of pain could be due to referred periosteal trauma and muscle spasms. Since spinal nerves exit posterior to the vertebral body, unless there was a crush or burst fracture involving the posterior portion of the body (along with the anterior part) they are not likely to be affected.25. T F Vertebral fractures have a longer healing time compared to 2extremity fractures.False The healing time is comparable.26. T F 25% of all women who have a hip fracture die within the first year.True (Baker) However,another source gives the mortality rate as high as 50%27. T F Half of all women and one eigth of all men will suffer osteoporotic fractures.True28. T F A person with osteoporosis and kyphosis cannot recover height that has been lost.False (Meeks) Clinical experience shows that up to one to two inches in height can be gained or restored through a comprehensive regimen of diet, medicine and PT.29. T F A person can lose spinal height without exhibiting kyphotic posture.True Disc dehydration may be the cause of spinal height loss, unrelated to osteoporosis. Also, bi-concave (codfish) [Marilyn: younger person with osteomalacia: hydrated disc and soft bodies] and crushvertebral fractures [MVA, SCI] will cause the loss of spinal