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Osteoporosis

OVERVIEW

Osteoporosis is a condition that affects more than 28 million women and men in the United States and results in more than 1.5 million fractures per year. The majority of fractures occur in the vertebrae, hip, and wrist, although any bone is susceptible. These fractures can result in significant morbidity and mortality and can compromise the quality of life for patients and their families.

Family physicians play an important role in both the prevention and treatment of osteoporosis because of their involvement in the lives of their patients across the life span. Early implementation of preventive measures, such as ensuring adequate calcium intake and recommending weight-bearing exercise, can influence patient outcomes in the future. Identification of patients with additional risk factors and application of appropriate screening and diagnostic tools can also result in early intervention of additional measures to treat osteoporosis and reduce the likelihood of a debilitating fracture.

TOPIC LEARNING GOALS AND OBJECTIVES

(Organized by ACGME Competencies)

Patient Care

GOAL: Students will demonstrate compassionate and effective care of the treatment of patients with osteoporosis.

OBJECTIVES: Students will be able to:

• Conduct a problem-focused appropriate examination of a patient with osteoporosis.
• Interpret bone density results in establishing a diagnosis of osteoporosis.

GOAL: Students will demonstrate effective preventive care of the patient at risk for osteoporosis.

OBJECTIVES: Students will be able to:

• Identify patients at risk for osteoporosis.
• Apply current and appropriate screening guidelines for the patient at risk for osteoporosis.

GOAL: Students will be sensitive to individual and cultural differences in their development of treatment plans.

OBJECTIVES: Students will be able to:

• Discuss with patients and families the importance of lifestyle changes in the management of osteoporosis.
• Develop a treatment plan for the patient with osteoporosis in the context of the patient's life and environment.

Medical Knowledge

GOAL: Students will demonstrate the application of evidence-based knowledge in patients with osteoporosis or at risk for osteoporosis.

OBJECTIVES: Students will be able to:

• Recognize the factors that increase the risk of osteoporosis.
• Explain the pharmacology of typical medications to prevent and treat osteoporosis.
• Identify nonpharmacological strategies used to prevent osteoporosis.

GOAL: Students will understand the pathophysiology and risks of untreated osteoporosis.

OBJECTIVES: Students will be able to:

• Describe the complications of osteoporosis.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of screening for osteoporosis in practice and community settings.

OBJECTIVES: Students will be able to:

• Describe how osteoporosis is monitored in the assigned clerkship site.
• Consider the impact of environment on adherence to treatment plans and lifestyle changes.

GOAL: Students will understand the role of practice-based improvement.

OBJECTIVES: Students will be able to:

• Recognize the importance of practice analysis for a population with osteoporosis.

GOAL: Students will bring up-to-date evidence to the point of clinical care.

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions in regard to osteoporosis.
• Use best evidence to answer clinical questions about osteoporosis.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of osteoporosis.

OBJECTIVES: Students will be able to:

• Counsel a patient at risk for osteoporosis.
• Include patients and families in the development of treatment plans for management and prevention of osteoporosis.
• Demonstrate effective listening skills and empathy to improve patient adherence to medications used to treat osteoporosis.

Professionalism

GOAL: Students will care for patients with osteoporosis from diverse patient backgrounds and at different points in their illness.

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
• Reflect on personal frustrations when patients are not adherent to plans.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of osteoporosis.

OBJECTIVES: Students will be able to:

• Describe cost-effective strategies for treatment of osteoporosis using different formularies.
• Analyze barriers to effective integrated treatment of osteoporosis.
• Consider the role of other disciplines (e.g., pharmacy, nursing, social work, and allied health) in the treatment of osteoporosis.

EDUCATIONAL METHODS AND RESOURCES

Small-Group Learning

• AFPRD Case Based Osteoporosis Curriculum
  http://www.afprd.org/betterbones.php

Problem-Based Learning

• Caryl Heaton, DO has a case
  
• Richard Usatine, MD has a doctoring case - osteoporosis, hip fracture, and home assessment

Learning Units

• AFPRD program with small-group, case-based discussions - Janice Nevin, MD
  
• PBL case - Caryl Heaton, DO, UMD-RWJ / UCLA Doctoring Curriculum

Lectures

• UMDRWJ - Contact Caryl Heaton, DO - PowerPoint presentation

Web Sites

• National Osteoporosis Foundation
  
• The National Resource Center, a part of the U.S. Department of Health and Human Services' National Institutes of Health (NIH), provides patients, health professionals, and the public with an important link to resources and information on metabolic bone diseases, including osteoporosis, Paget's disease of the bone, osteogenesis imperfecta, and hyperparathyroidism. The National Resource Center is dedicated to increasing the awareness, knowledge and understanding of physicians, health professionals, patients, underserved and at-risk populations (such as Hispanic and Asian women, adolescents, and men), and the general public about the prevention, early detection, and treatment of osteoporosis and related bone diseases.
  
  NIH ORBD~NRC bibliographies have been developed on a variety of topics. The information in these NIH ORBD~NRC bibliographies was compiled from "MEDLINE," one of the National Library of Medicine's "MEDLARS" databases. "MEDLINE" includes information from a variety of sources, some of which may be protected under U.S. Copyright Law. Users are referred to the source publication for applicable restrictions on the redistribution of copyrighted materials. The bibliographies that are available include:
• Alcohol and Osteoporosis
• Bisphosphonates
• Calcitonin Therapy
• Calcium
• Eating Disorders and Bone Density
• Estrogen
• Exercise and Postmenopausal Women
• Falls and Fall Prevention
• Female Athletes and Bone Health
• Fibrous Dysplasia/McCune-Albright Syndrome
• Glucocorticoid-Induced Osteoporosis
• Men and Osteoporosis
• Osteogenesis Imperfecta
• Osteopetrosis
• Osteoporosis and Smoking
• Osteoporosis Research in African Americans
• Osteoporosis Research in Asian Populations
• Osteoporosis Research in Hispanic Populations
• Paget's Disease of Bone
• Parathyroid Hormone Therapy
• Peak Bone Mass
• Primary Hyperparathyroidism
• Selective Estrogen Receptor Modulators (SERMs)
• Sodium Fluoride and Osteoporosis
• Topics in Osteoporosis
  http://www.osteofound.org/
  
• International Osteoporosis Foundation
  This site provides information about osteoporosis and member osteoporosis societies worldwide. 
  http://www.osteo.org/

ASSESSMENT STRATEGIES

Standardized Patient Cases

• Standardized patient (also menopause case & Spanish speaking patient) focuses on prevention- University of Colorado - Ann O'Brien-Gonzales, PhD

Lead Author: Janice Nevin, MD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

Revised November 6, 2003

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated October 17, 2005