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WELCOME TO IBONEACADEMY

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PATIENT CARE

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Osteoporosis-related fractures can impact a patient's life. Help your patients
strengthen their bones and reduce their risk for fractures.1-4

View the resources below to learn about the burden of osteoporosis, barriers to
medication adherence, and how healthcare professionals can help with disease
management.

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ANOTHER POINT OF VIEW: THE PERSPECTIVE OF THE PATIENT WITH OSTEOPOROSIS

Osteoporosis is a chronic disease that can impact a patient's life.3 Learn about
communication strategies that help patients understand their diagnosis and
treatment options.

Read Transcript
Osteoporosis screening, diagnosis, and treatment of high-risk patients

Screening for osteoporosis is the first step in mitigating fracture risk.3-5 In
this video, learn what key questions to ask to identify patients at risk for
osteoporosis and fractures, what tools can be used for risk assessment, and what
patients are at high risk for fracture and eligible for treatment.

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READ TRANSCRIPT
Patients are not taking their medications: Help them change their minds

Medication adherence is essential for reducing the risk of fractures.4,6 Learn
what keeps patients from taking their medications, understand their perspective,
and learn how you can provide guidance.

tes
What have we learned from modeling bone decay?

This unique perspective uses real data and cutting-edge algorithms to
demonstrate progressive bone loss associated with aging. The accelerated loss of
trabecular and cortical bone after menopause is a key contributor to future
fracture risk, which can be avoided with appropriate diagnosis and timely
treatment.2,3

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READ TRANSCRIPT

ANOTHER POINT OF VIEW: THE PERSPECTIVE OF THE PATIENT WITH OSTEOPOROSIS

Doctor: It’s not just a wrist fracture … your bone mineral density test at your
hip indicated that you have osteoporosis because your T-score is below minus
2.5.1,2

Having this first fracture increases your risk for having another fracture in
the future which could be at a different site.1,2

All of your other tests were normal. I recommend you start treatment for your
osteoporosis.

Patient thought bubble 1 (read in a whispering voice by patient): Osteoporosis?
I don’t know, that fall was an accident. I just need to focus on healing my
wrist and then I’ll be more careful.3-5

Patient comment bubble 1 (read in a regular voice by patient): I have seen media
reports about the side effects of those treatments.3-5 I need to do more
research … I don’t want to start treatment just yet.3-5

Thought bubble 1 (read in a quiet / frustrated voice by doctor): Why didn’t she
accept my recommendation?

Thought bubble (read in a whispering voice by doctor): I should re-read those
notes from that article about communication strategies that help osteoporosis
patients understand their diagnosis and the benefits and risks of treatment.3

Understand, acknowledge and discuss your patient's concerns, but also ensure
they understand that osteoporosis is a real disease that weakens their bones and
makes them more likely to break.1,6

While the fears of treatment side effects are real, ensure your patient
understands that osteoporosis is a chronic disease and for many, the risks of
the disease outweigh the risks of treatment.1

When discussing treatment options and the potential for adverse
events...consider presenting statistics in an understandable way by using
absolute numbers and visual aids.1

Present information in multiple forms to improve your patient’s understanding,
and retention of key details.1

Encourage your patient to ask questions which promotes shared decision making
and helps to identify what's most important to the patient and barriers to
management.1,7

Include lifestyle modifications as part of the overall treatment plan to help
counter the concern some patients may have that physicians view medication as
the only solution and help your patient feel more proactive about their
treatment.1,8

References

1. Camacho PM, et al. Endocr Pract. 2016;22(Suppl 4):1-42.
2. Siris ES, et al. JAMA. 2001;286:2815-2822.
3. Besser SJ, et al. Arch Osteoporos. 2012;7:115-124.
4. Cadarette SM, et al. Curr Opin Rheumatol. 2010;22:397-403.
5. Sambrook PN, et al. Med J Aust. 2010;193:154-156.
6. Güss CD, et al. Front Psychol. 2017;8:851.
7. Iversen MD, et al. Geriatr Phys Ther. 2011;34(2):72-81.
8. The Peter Sandman Risk Communication Website.
www.psandman.com/articles/covello.htm. Accessed February 13, 2018.


OSTEOPOROSIS SCREENING, DIAGNOSIS, AND TREATMENT OF HIGH-RISK PATIENTS

Over 200 million women worldwide are affected by osteoporosis.1

However, fewer than 1 in 5 women with postmenopausal osteoporosis will be
evaluated.2-4

And fewer than 1 in 3 postmenopausal women with osteoporosis are treated.5-13

Obtain a DXA scan in all women ≥ 65 and women older than 50 who have clinical
risk factors for osteoporosis.14-17

Understanding clinical risk factors for osteoporosis and fracture risk can help
in formulating the best questions to ask your patients for accurate screening
and diagnosis.14-18 Questions to consider asking your patients might be: Have
you ever experienced a fracture? Has anyone in your family? Have you had any
recent falls? Do you have prolonged unusual back pain? A yes, could indicate a
vertebral fracture. Are you taking medications that increase bone loss like
glucocorticoids? Or are you taking medications that increase your risk of
falling like narcotic analgesics? Have you experienced significant weight loss?
Do you consume alcohol or tobacco? Are you getting adequate calcium and vitamin
D in your diet? What is your level of activity?18

In addition to asking these questions, on your clinical examination, look for
kyphosis14,17,18 or height loss14-18 which are signs of osteoporosis, or
difficulty performing the get up and go test which indicates risk for falls.19
Further, in patients at risk, consider spine x-rays to identify unrecognized
vertebral fractures and consider adding "rule out vertebral fracture" to imaging
orders.15,16

Bone mineral density alone does not explain all fragility fracture risk. In fact
60% of women with fragility fractures have non-osteoporotic bone mineral density
(T-score >-2.5).14,20,21 Understanding clinical risk factors and BMD together
improve fracture risk prediction21 in these patients.

Determining a patient's fracture risk requires consideration of several clinical
risk factors of which a history of prior fracture, older age, and low bone
mineral density are most important, followed by other non-modifiable and
modifiable risk factors.16,22-25

Some non-modifiable risk factors influencing a patient's fracture risk include:
family history of hip fracture or osteoporosis, female sex, Asian or white
ethnicity, small frame, comorbid conditions.16,23-25 While some modifiable risk
factors include: estrogen deficiency, fall-related risk factors and inadequate
physical activity.16,23

There are several methods you can use to identify women over age 50 at high risk
for fracture that need treatment. Patients with a history of fracture at the hip
or spine are at a high risk for future fracture.16,26

Women over age 50 with bone mineral density T-scores below -2.5 are considered
osteoporotic and at high risk for future fracture.26

High risk patients are those women with FRAX 10-year probability of hip fracture
≥ 3%, or 10-year probability of major osteoporotic fracture ≥ 20%.26

Fragility fractures at the proximal humerus, pelvis, and in some cases wrist
qualify patients as high risk for future fracture, when occurring in combination
with low bone mineral density at the hip or spine.26 Please note that regional
thresholds and criteria for treatment eligibility may vary.

References

1. International Osteoporosis Foundation. Facts and statistics.
www.iofbonehealth.org/facts-statistics. Accessed February 13, 2018.
2. Boudreau DM, et al. J Am Geriatr Soc. 2017;65:1829-1835.
3. Fast Facts. Osteoporosis Canada.
https://osteoporosis.ca/about-the-disease/fast-facts/.
4. Nguyen TV, et al. Med J Aust. 2004;180:S18-22.
5. Yusuf AA, et al. Arch Osteoporos. 2016;11:31.
6. Spångéus A, et al. Ann Rheum Dis. 2017;76(suppl2):72.
7. Sanfélix-Genovés J, et al. Osteoporos Int. 2013;24:1045-1055.
8. Hadji P, et al. Dtsch Arztebl Int. 2013;110(4):52-7.
9. Viprey M, et al. PLoS ONE. 2015;10(12):e0143842.
10. Bell JS, et al. Aust Fam Physician. 2012;41:110-118.
11. Eisman J, et al. J Bone Miner Res. 2004;19:1969-75.
12. Taiwanese Guidelines for Prevention and Treatment of Osteoporosis. Taiwanese
Osteoporosis Association, 2013.
13. Boytsov NN, et al. Am J Med Qual. 2017;32(6):644-654.
14. Camacho PM, et al. Endocr Pract. 2016;22(suppl 4):1-42.
15. Papaioannou A, et al. CMAJ. 2010;182:1864-1873.
16. Cosman F, et al. Osteoporos Int. 2014;25:2359-2381.
17. Kanis JA, et al. Osteoporos Int. 2013;24:23-57.
18. Orimo H, et al. Arch Osteoporos. 2012;7:3-20.
19. Vondracek SF, et al. Clin lnterv Aging. 2009;4:121-136.
20. Siris ES, el al. JAMA. 2001;286:2815-2822.
21. Siris ES, et al. Arch Intern Med. 2004;164:1108-1112.
22. Kanis JA, et al. Bone. 2004;35:375-382.
23. Kanis JA, et al. Lancet. 2002;359:1929-1936.
24. Eisman JA, et al. J Bone Miner Res. 2012;27:2039-2046.
25. US Department of Health and Human Services. Bone health and osteoporosis: a
report of the surgeon general. 2004. Rockville, MD.
26. Siris ES, et al. Osteoporos Int. 2014;25:1439-1443.


WHAT HAVE WE LEARNED FROM MODELING BONE DECAY?

Osteoporosis is chronic and progressive in nature; when untreated there is
ongoing bone loss contributing to a weakened skeleton and increased risk of
fracture.1

Bone mass decreases gradually after achieving its peak at 30 years of age.2,3

After menopause, there can be accelerated loss of both trabecular and cortical
bone ongoing with age4 that compromises bone strength and predisposes to
fracture.

This is what healthy bone looks like at age 35. As bone loss progresses with age
it continues to deteriorate in structural integrity.5,6

Here is a bone at age 44.5,6

Here is a bone at age 51.5,6

Here is a bone at age 65.5,6

Progressive bone loss is a key contributor to increased fracture risk with
age.5,6

This is the bone structure of a 74-year-old female who suffered an osteoporotic
hip fracture.5,6

For patients with osteoporosis, a timely diagnosis and appropriate treatment can
reduce the risk of fractures.

References

1. Hanley DA, et al. Am J Med. 2017;130:862.e1-862.e7.
2. Zebaze RM, et al. Lancet. 2010;375:1729-1736.
3. Recker RR, et al. JAMA. 1992;268(17):2403-2408.
4. Khosla S, et al. Endocrinol Metab Clin North Am. 2005;34:1015-1030.
5. Muller R. Osteoporos Int. 2005;16(Suppl 2):S25-S35.
6. Schulte FA, et al. Bone. 2011;49:1166-1172.


EXPLORE FRAGILITY FRACTURE PREVALENCE IN YOUR AREA

VIEW TOOLS


1. International Osteoporosis Foundation.
https://www.osteoporosis.foundation/facts-statistics/epidemiology-of-osteoporosis-and-fragility-fractures.
Accessed January 18, 2021. 2. U.S. Department of Health and Human Services. Bone
Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: US Dept
of Health and Human Services, Office of Surgeon General, 2004. 3. National
Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of
Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2014. 4. Camacho
PM, et al. Endocr Pract. 2020;26(suppl 1):1-46. 5. Papaioannou A, et al. CMAJ.
2010;182:1864-1873. 6. Walters S, et al. Clin Interv Aging. 2017;12:117-127.

These materials are provided for educational and non-commercial purposes only.
All materials provided herein are licensed for use only under the Creative
Common Attribution-Non-Commercial-No Derivatives 4.0 International Public
License linked here.

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