1. A 65-year-old woman with a history of early menopause presents with back pain and height loss. Radiographs show vertebral compression fractures. Which bone resorption marker would you expect to be elevated?
- A) Alkaline phosphatase
- B) Osteocalcin
- C) N-telopeptide (NTX)
- D) Vitamin D
2. A patient on long-term glucocorticoid therapy for rheumatoid arthritis is at risk for:
- A) Bone formation
- B) Increased bone resorption
- C) Decreased parathyroid hormone secretion
- D) Increased bone density
3. In a patient with primary hyperparathyroidism, how does the parathyroid hormone affect bone resorption?
- A) It inhibits osteoclast activity
- B) It stimulates osteoclast activity
- C) It has no effect on bone resorption
- D) It enhances bone formation
4. A 55-year-old man with a recent diagnosis of multiple myeloma is at an increased risk for:
- A) Pathologic fractures due to increased bone resorption
- B) Osteoblastic bone lesions
- C) Decreased serum calcium
- D) Bone marrow suppression without bone effects
5. Which medication is primarily used to reduce bone resorption in patients with osteoporosis?
- A) Vitamin D supplements
- B) Calcium
- C) Bisphosphonates
- D) Estrogen
6. A 70-year-old woman with osteoporosis is started on denosumab. This drug works by:
- A) Inhibiting RANKL, thus reducing osteoclast activity
- B) Increasing calcium absorption in the gut
- C) Stimulating osteoblast activity
- D) Directly killing osteoclasts
7. A patient presents with hypercalcemia, bone pain, and elevated serum levels of PTH-related protein (PTHrP). These findings are most consistent with:
- A) Primary hyperparathyroidism
- B) Malignancy-associated hypercalcemia
- C) Vitamin D toxicity
- D) Osteomalacia
8. In a patient with Paget’s disease of bone, which of the following is true regarding bone resorption?
- A) Bone resorption is decreased
- B) There is increased and disorganized bone resorption
- C) Osteoclasts are inhibited
- D) Bone density is uniformly increased
9. A 60-year-old man with type 2 diabetes and peripheral neuropathy shows signs of Charcot foot. What’s the primary concern regarding bone resorption in this scenario?
- A) Increased bone resorption leading to bone destruction
- B) Decreased bone turnover
- C) Enhanced bone healing
- D) No effect on bone resorption
10. Which of the following scenarios would most likely lead to increased bone resorption?
- A) High physical activity
- B) Prolonged bed rest
- C) High calcium diet
- D) Vitamin D supplementation
11. A postmenopausal woman with a T-score of -2.5 on DXA scan is diagnosed with osteoporosis. Which of these treatments would most directly target bone resorption?
- A) Teriparatide
- B) Alendronate
- C) Calcitonin
- D) Strontium ranelate
12. In a patient with chronic kidney disease, bone resorption can be complicated by:
- A) Increased vitamin D activation
- B) Secondary hyperparathyroidism
- C) Decreased bone turnover
- D) Enhanced osteoblast function
13. A 50-year-old woman presents with bone pain, hypercalcemia, and a serum electrophoresis showing an M-spike. What is the most likely diagnosis?
- A) Osteoporosis
- B) Multiple myeloma
- C) Osteomalacia
- D) Hyperparathyroidism
14. Which of the following is a direct measurement of bone resorption?
- A) Serum calcium level
- B) Serum phosphate level
- C) C-telopeptide (CTX)
- D) Bone-specific alkaline phosphatase
15. A patient with breast cancer develops bone metastases. What is the primary effect on bone resorption?
- A) Increased osteoclast activity leading to bone destruction
- B) Inhibition of bone resorption
- C) Increased bone formation
- D) No change in bone turnover
16. An elderly patient on long-term proton pump inhibitors (PPIs) is at risk for:
- A) Increased bone formation
- B) Increased bone resorption and fracture risk
- C) Decreased calcium absorption with no bone effect
- D) Bone healing
17. A patient with a history of bariatric surgery presents with osteopenia. Which vitamin deficiency is likely contributing to increased bone resorption?
- A) Vitamin B12
- B) Vitamin K
- C) Vitamin D
- D) Vitamin E
18. In a patient with osteoporosis, which of the following would indicate that bone resorption is effectively reduced by treatment?
- A) Increased serum calcium
- B) Increased alkaline phosphatase
- C) Decreased urinary NTX
- D) Increased osteocalcin
19. A 58-year-old woman with a history of smoking and low calcium intake shows signs of accelerated bone loss. Which imaging modality would best assess bone resorption?
- A) MRI
- B) CT scan
- C) Dual-energy X-ray absorptiometry (DXA)
- D) Ultrasound
20. A patient with hyperthyroidism might exhibit:
- A) Decreased bone turnover
- B) Increased bone resorption
- C) Increased bone density
- D) No effect on bone metabolism
21. Which of the following lifestyle choices has the least impact on reducing bone resorption?
- A) Weight-bearing exercise
- B) Adequate calcium intake
- C) Smoking
- D) Vitamin D supplementation
22. In a patient with postmenopausal osteoporosis, which hormone’s deficiency primarily contributes to increased bone resorption?
- A) Thyroid hormone
- B) Estrogen
- C) Insulin
- D) Cortisol
23. A patient with renal osteodystrophy might develop:
- A) Osteitis fibrosa cystica due to increased bone resorption
- B) Osteosclerosis
- C) Decreased bone resorption
- D) No bone changes
24. Which of these conditions is NOT typically associated with increased bone resorption?
- A) Hyperparathyroidism
- B) Osteoporosis
- C) Osteopetrosis
- D) Multiple myeloma
25. A patient with a high turnover osteoporosis would benefit most from:
- A) Calcium supplements alone
- B) Antiresorptive therapy like bisphosphonates
- C) Anabolic agents like teriparatide
- D) Dietary changes without medication
26. In a patient with rheumatoid arthritis, what contributes to bone loss?
- A) Increased osteoblast activity
- B) Inflammation leading to increased bone resorption
- C) Decreased parathyroid hormone
- D) High calcium levels in serum
27. A patient on aromatase inhibitors for breast cancer might experience:
- A) Enhanced bone formation
- B) Increased bone resorption leading to bone loss
- C) No changes in bone metabolism
- D) Decreased bone resorption
28. Which bone marker would you monitor to assess the effectiveness of an antiresorptive treatment in osteoporosis?
- A) Alkaline phosphatase
- B) Osteocalcin
- C) Serum CTX
- D) Parathyroid hormone
29. A patient with Cushing’s syndrome might exhibit:
- A) Increased bone resorption and osteoporosis
- B) Increased bone density
- C) Decreased bone turnover
- D) No bone effects
30. In a patient with severe vitamin D deficiency, bone resorption is likely increased due to:
- A) Direct inhibition of osteoclasts
- B) Secondary hyperparathyroidism
- C) Increased bone mineralization
- D) Decreased bone remodeling
31. Which of the following is an example of a disease with local bone resorption rather than systemic?
- A) Osteoporosis
- B) Hyperparathyroidism
- C) Periodontitis
- D) Paget’s disease
32. A patient on chronic heparin therapy might develop:
- A) Increased bone formation
- B) Osteoporosis due to increased bone resorption
- C) Decreased bone resorption
- D) No effect on bone
33. In a patient with a recent spinal cord injury, what is expected regarding bone metabolism?
- A) Increased bone resorption due to immobilization
- B) Decreased bone resorption
- C) Increased bone formation
- D) No change in bone turnover
34. Which of the following is a consequence of excessive bone resorption in the jaw?
- A) Increased jaw strength
- B) Osteonecrosis of the jaw
- C) Decreased tooth mobility
- D) Enhanced bone regeneration
35. A patient with a history of anorexia nervosa is at risk for:
- A) Increased bone density
- B) Osteopenia or osteoporosis due to increased bone resorption
- C) Decreased bone resorption
- D) Enhanced bone healing
36. In a patient with hypercalciuria, which process is likely altered?
- A) Bone formation is increased
- B) Bone resorption is increased
- C) Calcium absorption is decreased
- D) No bone changes
37. What’s the primary mechanism by which bisphosphonates work?
- A) They promote osteoblast activity
- B) They inhibit osteoclast-mediated bone resorption
- C) They increase calcium absorption
- D) They stimulate vitamin D synthesis
38. A patient with a high serum level of bone-specific alkaline phosphatase indicates:
- A) Decreased bone resorption
- B) Increased bone turnover
- C) Decreased bone formation
- D) No change in bone metabolism
39. In postmenopausal women, which hormone change directly contributes to bone loss?
- A) Increase in progesterone
- B) Decrease in estrogen
- C) Increase in testosterone
- D) Decrease in cortisol
40. Which of these is NOT an effect of excessive bone resorption?
- A) Fractures
- B) Loss of height
- C) Bone pain
- D) Increased bone density
41. A patient with a history of gastric bypass surgery might experience increased bone resorption due to:
- A) Malabsorption of calcium and vitamin D
- B) Increased bone formation
- C) Decreased bone resorption
- D) Enhanced bone mineralization
42. Which scenario would NOT typically lead to increased bone resorption?
- A) Immobility after hip fracture
- B) Hypogonadism
- C) High-impact exercise
- D) Chronic alcohol abuse
43. In a patient with Gaucher’s disease, bone resorption might be increased due to:
- A) Increased bone density
- B) Bone marrow infiltration by Gaucher cells
- C) Decreased osteoclast activity
- D) Enhanced bone formation
44. Which treatment for osteoporosis aims at both reducing bone resorption and increasing bone formation?
- A) Bisphosphonates
- B) Selective estrogen receptor modulators (SERMs)
- C) Teriparatide
- D) Calcitonin
45. A patient with osteogenesis imperfecta would primarily show:
- A) Increased bone density
- B) Increased bone resorption leading to brittle bones
- C) Decreased bone resorption
- D) No changes in bone metabolism
46. In patients with chronic liver disease, bone resorption can be increased due to:
- A) Increased vitamin D activation
- B) Secondary hyperparathyroidism due to vitamin D deficiency
- C) Enhanced bone formation
- D) Decreased bone turnover
47. A patient with a high level of tartrate-resistant acid phosphatase (TRAP) in blood suggests:
- A) Decreased osteoclast activity
- B) Increased osteoclast activity
- C) Decreased bone resorption
- D) No relevance to bone metabolism
48. Which condition would most likely present with both increased bone resorption and formation?
- A) Osteoporosis
- B) Osteomalacia
- C) Paget’s disease of bone
- D) Osteopetrosis
49. In a patient undergoing chemotherapy for lymphoma, bone resorption might be increased due to:
- A) Direct stimulation of osteoblasts
- B) Tumor-induced osteoclast activation
- C) Decreased bone resorption
- D) Enhanced bone formation
50. A patient with primary biliary cirrhosis might develop bone disease characterized by:
- A) Increased bone density
- B) Osteopenia or osteoporosis due to increased bone resorption
- C) Decreased bone resorption
- D) Normal bone metabolism