An interview with Jeffrey P. Levine, MD, MPH

Jeffrey P. Levine, MD, MPH
Professor and Director of Womens Health Programs
Department of Family Medicine
Master Educators Guild
UMDNJ-Robert Wood Johnson Medical School
New Brunswick , NJ

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?

There are several reasons why Osteoporosis screening rates have not improved:

1. Osteoporosis screening guidelines are not clear. Different screening recommendations from various organizations, such as the NOF, AACE, and USPSTF can be confusing and appear to conflict one another.
2. Osteoporosis screening is a relatively low priority for most primary care clinicians because patients often have too many other medical concerns / conditions to address during the limited time of an office visit.
3. Osteoporosis is a low priority for most patients. Osteoporosis remains a silent disease until they experience a fracture.
4. The public perception is that Osteoporosis is not a major public health problem; that it is a condition created by the pharmaceutical industry to sell drugs.
5. There is a lack of patient access to DXA facilities due to financial limitations and issues of distance to travel for testing.
6. Reduced DXA reimbursement, leading to less Osteoporosis screening promotion, is a barrier to testing patients.
7. There exists generalized confusion regarding how best to interpret DXA results, leading to negative reinforcement for obtaining BMD testing on future patients.

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

Routinely assess their patients risk for Osteoporosis and related fractures via written questionnaire, nurse assessment, physician history taking, or mailed patient education.

Integrate a BMD screening tickler/reminder system into EMR, paper chart, or scheduling, at least for all women >65 years of age and men over 70 years, as well as for those patients already on pharmacologic treatment.

Provide patient educational materials regarding Osteoporosis prevention and screening in the waiting room and patient rooms.

Keep up to date with the latest evidence-based guidelines for Osteoporosis screening and treatment.

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?

Broader adoption of the latest NOF guidelines for prevention, screening, and treatment, combined with timely pharmacologic treatment initiation, monitoring and improved patient compliance, can dramatically reduce the prevalence of patients with Osteoporosis and the incidence of subsequent fractures.

What can physicians do to stem the tide in Osteoporosis?

As above

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

Integrating FRAX into primary care practice

Practical & effective strategies to improve patient selection, adherence, and compliance for Osteoporosis medications.

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

It would depend on the target audience. Live meetings are effective for most. Podcasts and webcasts work for younger and more internet-savvy clinicians.

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

Flexibility and improved access. On-line programs are much easier than reading a lot of articles to get up to date. On-line program also usually provide more recent information than monographs.

Negative press about Osteoporosis therapies continues, leading to negative reinforcement for both patients and clinicians to discuss.