An interview with E. Michael Lewiecki, MD, FACP, FACE

E. Michael Lewiecki, MD, FACP, FACE
Osteoporosis Director,
New Mexico Clinical Research & Osteoporosis Center
Clinical Assistant Professor of Medicine,
University of New Mexico School of Medicine
Albuquerque, NM

Why haven’t screening rates for patients at risk of developing osteoporosis improved, in spite of all the evidence supporting the need to screen the at-risk patient?

Most osteoporosis care is provided by primary care physicians. Osteoporosis is a silent disease that is often not considered, even after a low trauma fracture occurs. Factors that contribute to low screening rates include competing healthcare priorities, limited time, poor awareness of clinical practice guidelines, and health plan restrictions on coverage for bone density testing.

What can the medical community do to improve screening rates? More patient education? More physician education on risk-factors and guidelines?

Disease-state education of patients and physicians, including attempts to improve awareness of clinical practice guidelines, are important but not enough. An “osteoporosis champion” (e.g., a nurse or medical assistant) in each physician’s office may help to identify patients who need further evaluation and treatment. Ultimately, systems-based approaches, where interventions are mandated in closed-panel healthcare systems, are probably most likely to improve clinical outcomes.

Morbidity and mortality figures associated with osteoporosis are staggering, especially when they are compared to rates of other diseases, such as heart disease and breast cancer in women. What is the potential for improving these figures with increased screening, improved therapies, and increased compliance?

There is good evidence that osteoporosis-related healthcare outcomes can be improved through systems-based changes in patient management. Several studies have reported reductions in fracture rates and reduced healthcare expenses associated with improved screening and treatment of patients at high risk for fracture.

What can primary care physicians do to stem the tide in osteoporosis?

First, recognize that any adult with a previous low-trauma fracture is likely to have osteoporosis; further evaluation with bone density testing, assessment of factors contributing to skeletal fragility, and initiation of pharmacological therapy may be indicated. Second, consider screening bone density testing for all women age 65 and older, younger postmenopausal women with risk factors for fracture, all men age 70 and older, and all men age 50-70 with risk factors for fracture. Finally, for all patients, discuss the benefits of a healthy lifestyle and good nutrition, with particular attention to adequacy of calcium and vitamin D intake.

What topics related to your practice would you like to see addressed in future educational activities?

Risk communication, shared decision making, monitoring therapy.

What do you perceive to be the most effective methods of CME delivery now and in the future?

Interactive discussions, case-based presentations.

What value do on-line programs like the CME-Lounge offer your peers?

Low cost, easy access, with discussion between experts serving as a surrogate for first-hand discussion.