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Supplements Fracture Prevention in Osteoporosis
Managing Osteoporosis in a Managed Care Population
Christina Barrington, PharmD; Michael Baxley, MD; Luis Estevez, MD, MPH, MBA; John Fox, MD; Robert Gregory, RPh, MS, MBA; Sonya J. Lewis, RPh, MBA; Bonnie May, RPh, MBA; Bruce Niebylski, MD
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Participating Faculty
Introduction: Fracture Prevention
Importance of Early Diagnosis and Treatment of Osteoporosis to Prevent Fractures
Joseph R. Tucci, MD


Fracture Prevention in Osteoporosis


The University of Cincinnati College of Medicine designates this educational activity for a maximum of two (2) AMA PRA Category 1 CME Creditsâ„¢. Physicians should only claim credit commensurate with the extent of their participation in this activity.

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians.

The GMR Group-Health Insights is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation and is a provider approved by the California Board of Registered Nursing, California Provider # CEP 12643.

The GMR Group-Health Insights is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This program offers a total of 1.75 contact hours or 0.175 CEUs. ACPE # 404-000-06-001-H01.


After reading "Fracture Prevention in Osteoporosis" please complete the program evaluation and fill out the answer key for each of the following questions.

1. According to the National Osteoporosis Foundation, how many individuals in the United States have, or are at risk for, osteoporosis?

  1. 12 million
  2. 20 million
  3. 34 million
  4. 50 million

2. Osteoporosis has been estimated to result in how many fragility fractures yearly?

  1. 1 million
  2. 1.5 million
  3. 3 million
  4. 5 million

3. The majority of osteoporosis-related fractures are _____.

  1. vertebral
  2. nonvertebral
  3. pelvic
  4. infection related

4. Absent osteoporosis, bone turnover _____.

  1. favors bone deposition
  2. favors bone resorption
  3. remains stable
  4. ceases

5. By 2020, yearly healthcare spending for osteoporotic-related fracture in the United States is expected to reach _____.

  1. $12 billion to $20 billion
  2. $21 billion to $27 billion
  3. $31 billion to $62 billion
  4. $70 billion to $81 billion

6. Risk factors for osteoporosis-related fracture include which of the following?

  1. Previous fragility fracture
  2. Low body mass index
  3. Female gender
  4. All of the above

7. Which of the following is a possible physical sign of vertebral fracture?

  1. Height loss
  2. Arm span loss
  3. Fever
  4. Leg length loss

8. Which of the following is a biochemical marker of bone formation?

  1. N-telopeptide
  2. C-telopeptide
  3. Osteocalcin
  4. Deoxypyridinoline

9. The World Health Organization defines the threshold for a diagnosis of osteoporosis as a T-score of less than _____.

  1. 1
  2. -1
  3. -2.5
  4. -3

10. Medicare covers bone mineral density (BMD) testing every 2 years for which of the following groups?

  1. Estrogen-deficient women at a clinical risk for osteoporosis.
  2. Individuals with nonvertebral abnormalities demonstrated by x-ray.
  3. Individuals with primary hypothyroidism.
  4. All of the above

11. In the National Osteoporosis Risk Assessment study, the presence of osteopenia increased the risk for fracture by _____.

  1. 2-fold
  2. 4-fold
  3. 5-fold
  4. 6-fold

12. In the Study of Osteoporotic Fracture trial, the risk for hip fracture in women over the age of 65 years increased _____.

  1. directly as BMD decreased
  2. particularly rapidly in smokers
  3. as risk factors–such as low BMD, previous fracture type, and previous hyperthyroidism–accumulated
  4. as caffeine use decreased

13. The National Osteoporosis Foundation advocates starting pharmacotherapy to reduce fracture risk in which groups of women?

  1. T-score <-2.0 by hip dual-energy x-ray absorptiometry (DXA) with no risk factors.
  2. T-score <-1.5 by hip DXA with 1 or more risk factors.
  3. A prior vertebral or hip fracture.
  4. All of the above

14. Alendronate has been shown to reduce the risk for vertebral and nonvertebral fracture _____.

  1. in women only
  2. in men and women
  3. after 6 months of treatment
  4. in men and women without prior fractures

15. After starting therapy, risedronate reduces the risk for vertebral and nonvertebral fracture within _____.

  1. 2 months
  2. 4 months
  3. 6 months
  4. 12 months

16. In reducing the risk for nonvertebral fracture, calcitonin has been shown to be less effective than either _____.

  1. risedronate or alendronate
  2. alendronate or raloxifene
  3. raloxifene or teriparatide
  4. risedronate or raloxifene

17. A study using "real-world" data from the Protocare Sciences Integrated Medical and Pharmaceutical Claims Database demonstrated that, compared with calcitonin or alendronate treatment, risedronate reduced the adjusted risk for nonvertebral fracture at 6 months by _____.

  1. 26%
  2. 54%
  3. 65%
  4. 71%

18. The results of an observational study using data from the Protocare Sciences Database indicated that the annual nonvertebral fracture-related medical cost in patients treated with risedronate is _____.

  1. $110
  2. $210 less than that for alendronate
  3. $402 less than that for calcitonin
  4. All of the above

19. In the study by Miller, using data from the Protocare Sciences Database, the risk for gastrointestinal (GI) side effects in patients with a history of GI events was _____.

  1. 44% higher with alendronate versus risedronate
  2. 49% higher with alendronate versus risedronate
  3. the same for alendronate and risedronate
  4. 44% lower with alendronate versus risedronate

20. In the observational cost analysis study by Kane, the annual direct medical costs for GI events in patients treated with risedronate were _____.

  1. higher than those in patients treated with alendronate
  2. higher than those in patients treated with calcitonin
  3. about $45,000 lower than in patients treated with alendronate
  4. about $4000 lower than in patients treated with alendronate


To enhance understanding of current practices in fracture prevention.


Managed care pharmacy directors, medical directors, and other managed care executives . . .


Upon completion of this activity, participants will be able to:

  • Define the current management practices for osteoporosis–nonpharmacologic, pharmacologic
  • Discuss the value of fracture reduction vs bone mineral density as it relates to outcomes and the impact on the healthcare system
  • Define the various drug classes used to prevent/treat osteoporosis and appropriate utilization of these agents
  • List the key concerns for managed care that would preclude achieving optimal results in osteoporosis management
  • Determine the impact of the Medicare Modernization Act legislation as it relates to osteoporosis management

There is no fee for this program.

Expiration date: 05-31-07


This publication was made possible by funding from The Alliance for Better Bone Health, P&G/Sanofi-Aventis.


The contents of this supplement may include information regarding the use of products that may be inconsistent outside the approved labeling for these products in the United States. Physicians should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products.

Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
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