American Board of Internal Medicine (ABIM) Certification Practice Exam

When should patients with giant cell arteritis undergo osteoporosis screening?

1. When starting biologic therapy

2. At the time of diagnosis of giant cell arteritis

3. When starting steroids

4. Every six months

The correct answer is: When starting steroids

Patients with giant cell arteritis should undergo osteoporosis screening when starting steroids. This is due to the well-established fact that glucocorticoids, such as those commonly used to treat giant cell arteritis, can have significant effects on bone health and are associated with increased risk of osteoporosis and fractures, especially when used at high doses or for prolonged periods. Initiating steroid therapy can lead to rapid bone density loss, making it crucial to assess the patient's bone health status prior to starting treatment. Identifying individuals at risk for osteoporosis at this time allows for timely intervention, including lifestyle modifications, supplementation, or additional medications such as bisphosphonates, to mitigate the risk of osteoporotic fractures. Other contexts, such as the time of diagnosis or starting biologic therapy, may not provide the same immediate concern regarding osteoporosis risk as the initiation of steroid therapy does. Regular screening every six months may not be necessary unless there are other risk factors or the patient remains on steroids long-term. Therefore, screening at the initiation of steroid therapy is the most appropriate and timely point for intervention, given the potential impact of steroids on bone health.