Latest / Becker’s Healthcare Podcast / Uniting to Close the Osteoporosis Care Gap

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Uniting to Close the Osteoporosis Care Gap · Becker’s Healthcare Podcast

• 0:00
  - Welcome to the Becker's Healthcare Podcast. Today's episode
• 0:03
  - focuses on the Osteoporosis
• 0:04
  - Action Network, an interdisciplinary
• 0:07
  - group of osteoporosis
• 0:08
  - leaders focused on empowering patients and clinicians
• 0:12
  - to drive change in osteoporosis
• 0:14
  - care with a bold ambition to prevent three
• 0:17
  - million fractures by 2033.
• 0:20
  - This episode is sponsored by Amgen as part
• 0:22
  - of a podcast series on post fracture care.
• 0:25
  - And with that, I'll turn the floor over
• 0:27
  - to Amgen's Poonamaju.
• 0:29
  - Hi, everyone. I'm pleased to be part of
• 0:31
  - today's Becker's podcast episode.
• 0:34
  - My name is Poonamaju. I am a marketing
• 0:36
  - director at Amgen in the bone health team.
• 0:38
  - I'm here today with doctor Rita Roy from
• 0:40
  - the Spine Health Foundation and doctor Susan Bakata
• 0:43
  - from UC San Diego Health. Hi. Thank you,
• 0:45
  - Poona. My name is Rita Roy. I'm the
• 0:47
  - CEO of the Spine Health Foundation.
• 0:50
  - And hello. My name is Susan Bukhara. I'm
• 0:52
  - a board certified orthopedic surgeon, professor and chair
• 0:55
  - of orthopedic surgery at UC San Diego.
• 0:59
  - Thank you both for joining me today to
• 1:00
  - discuss the Osteoporosis
• 1:02
  - Action Network and its mission to reduce the
• 1:04
  - risk of osteoporosis
• 1:06
  - related fractures.
• 1:07
  - To kick things off, Susan, could you ground
• 1:09
  - the listeners in why osteoporosis
• 1:11
  - prevention,
• 1:13
  - diagnosis,
• 1:14
  - and post fracture care remain urgent issues today?
• 1:18
  - Absolutely, Poonam.
• 1:19
  - This is a massive public health problem. It
• 1:22
  - is so common.
• 1:23
  - We see it everywhere, but we don't see
• 1:25
  - it at all. And the burden of osteoporosis
• 1:28
  - and fracture remains massive, and it's largely unaddressed.
• 1:32
  - There are two million osteoporosis
• 1:34
  - related fractures each year in The United States,
• 1:37
  - and more than five hundred thousand of them
• 1:39
  - result in hospitalizations.
• 1:41
  - If you take hospitalizations
• 1:42
  - for stroke, you take hospitalizations
• 1:44
  - for heart attack, and you take hospitalizations
• 1:47
  - for breast cancer for women,
• 1:49
  - none of those come close to those five
• 1:51
  - hundred thousand
• 1:52
  - of hospitalizations
• 1:53
  - that happen for fragility fractures.
• 1:56
  - And once you've had a fragility fracture, you
• 1:58
  - are much more likely to have another fragility
• 2:00
  - fracture.
• 2:01
  - Within a year, ten percent will have another
• 2:03
  - fracture. Within five years, thirty percent of patients
• 2:06
  - will have another fracture.
• 2:08
  - Yet only twelve percent of women who've had
• 2:11
  - a fragility fracture
• 2:13
  - wind up getting on some sort of treatment
• 2:15
  - within a year of that fragility fracture.
• 2:17
  - And eighty three percent of patients
• 2:20
  - it's never talked about. They don't even connect
• 2:22
  - into the conversation about osteoporosis
• 2:25
  - and ways to prevent future fractures. And so
• 2:28
  - there's a tremendous
• 2:29
  - need for us to get to this. Imagine
• 2:31
  - having a heart attack
• 2:33
  - and leaving the hospital and people being like,
• 2:35
  - good luck. Maybe or maybe not, you'll have
• 2:37
  - a problem in the future. And yet we
• 2:39
  - do that with osteoporosis
• 2:40
  - every day. Thanks, Susan.
• 2:42
  - Rita, this is such a big problem.
• 2:44
  - What made it clear that this problem there's
• 2:47
  - no one single organization can solve it alone?
• 2:50
  - And so what are groups hoping to do
• 2:52
  - differently to bring voices together?
• 2:55
  - Yeah. Thank you for that question, Poonam. It's
• 2:57
  - so important. You know, osteoporosis
• 3:00
  - can often be dismissed as just a regular
• 3:03
  - part of aging, and it's not owned by
• 3:06
  - any one medical specialty.
• 3:08
  - What we've seen is that everyone thinks the
• 3:10
  - primary care physician will just handle it when
• 3:13
  - actually primary care is overwhelmed with so many
• 3:16
  - issues, they may not have the capacity to
• 3:18
  - treat the osteoporosis.
• 3:20
  - And so while there are many endocrinologists
• 3:22
  - and rheumatologists
• 3:23
  - managing osteoporosis,
• 3:25
  - the orthopedist
• 3:26
  - and spine surgeons are critical
• 3:28
  - in identifying
• 3:29
  - the post fracture patients for treatment. That means
• 3:32
  - identifying
• 3:33
  - the patients who've had a fracture,
• 3:36
  - from osteoporosis
• 3:37
  - and now need treatment for that osteoporosis
• 3:40
  - so that they don't fracture again. Like doctor
• 3:42
  - Bakata was saying, the huge number of people
• 3:45
  - that will have a secondary fracture
• 3:47
  - after that first fracture. So this is where
• 3:50
  - we focused our work at the Spine Health
• 3:51
  - Foundation. And and with that context in mind,
• 3:55
  - we know that
• 3:56
  - driving action to address osteoporosis
• 3:59
  - would not be solved by one group alone,
• 4:01
  - and we've gotta change the narrative around the
• 4:04
  - disease. And so
• 4:05
  - in doing so,
• 4:06
  - bringing multiple stakeholders together from a wide variety
• 4:10
  - of perspectives
• 4:11
  - is going to be important in in raising
• 4:14
  - all those voices in one loud chorus.
• 4:17
  - We think of it like a symphony. There
• 4:18
  - are all these different specialties
• 4:20
  - that come together to create this big, beautiful
• 4:23
  - sound
• 4:24
  - of raising awareness and closing treatment gap. And
• 4:27
  - so that's where the Osteoporosis Action Network comes
• 4:30
  - in. It's it's a coalition of experienced osteoporosis
• 4:33
  - leaders and industry partners
• 4:35
  - that includes researchers, clinicians,
• 4:38
  - medical societies, and patient advocates,
• 4:41
  - all committed to accelerating
• 4:44
  - progress
• 4:44
  - in the osteoporosis
• 4:46
  - prevention,
• 4:47
  - the diagnosis,
• 4:49
  - and the care,
• 4:50
  - bringing these diverse stakeholders together around shared priorities
• 4:54
  - and action. And so,
• 4:56
  - you know, it's it's it's very exciting
• 4:58
  - that all these groups can come together, and
• 5:01
  - the initial support
• 5:02
  - for this osteoporosis
• 5:04
  - action network is being provided by Amgen.
• 5:07
  - The mission of the group is to reduce
• 5:09
  - fracture risk
• 5:11
  - by empowering
• 5:12
  - clinicians and patients
• 5:14
  - to drive systemic changes
• 5:17
  - with this immediate focus on redefining
• 5:20
  - the standard of care
• 5:22
  - in post fracture services. That means
• 5:25
  - after a fracture has happened, we can't just
• 5:28
  - let people,
• 5:29
  - you know, flounder with their osteoporosis and do
• 5:32
  - nothing about it. So we wanna look at
• 5:34
  - that really big moment there,
• 5:37
  - to provide education,
• 5:38
  - to provide to provide understanding, and to provide
• 5:42
  - urgent action.
• 5:43
  - People make analogies to cardiology.
• 5:46
  - Like, if you have a heart attack, you're
• 5:48
  - not just gonna be sent out the door
• 5:49
  - with no no follow-up, no treatment for your
• 5:52
  - cardiovascular
• 5:53
  - care. Same should be true for your bone
• 5:55
  - health.
• 5:56
  - And so all of this is being done
• 5:58
  - in in service to, you know, a vision
• 6:00
  - of a world where osteoporosis related fractures are
• 6:03
  - rare,
• 6:05
  - where strong bones are commonly believed to support
• 6:08
  - overall health, that concept of the health span,
• 6:11
  - right, to living well longer, and that involves
• 6:15
  - taking care of your bones.
• 6:17
  - The goal of OAN
• 6:19
  - is to prevent three million fractures by 2033.
• 6:24
  - That is not a small feat.
• 6:26
  - And, and the OAN was created in an
• 6:29
  - effort to combine all of these individual efforts,
• 6:33
  - again, into that strong
• 6:34
  - collective voice,
• 6:36
  - advocating for progress
• 6:38
  - in osteoporosis care and closing that treatment gap.
• 6:42
  - And what we see our group doing differently
• 6:45
  - is, again, driving the urgency and action in
• 6:48
  - osteoporosis care
• 6:50
  - Again, leveraging the wide range of backgrounds and
• 6:52
  - professions in the coalition
• 6:54
  - to show the disease it's not confined to
• 6:57
  - any one area of the health care system
• 6:59
  - alone, and, collectively,
• 7:01
  - we all have a role
• 7:03
  - to fix this. Thanks, Rita. That is so
• 7:06
  - empowering,
• 7:07
  - and that's a big lofty goal too. So
• 7:09
  - as you think about the co coalition getting
• 7:11
  - underway and taking actions, what are the most
• 7:14
  - important areas of focus?
• 7:16
  - Yeah. Thanks for that question, Poonam. I have
• 7:18
  - a lot to say about that.
• 7:20
  - So,
• 7:21
  - our objectives in the OAN are is sort
• 7:24
  - of the first priority is to elevate
• 7:27
  - osteoporosis
• 7:28
  - and secondary
• 7:30
  - fracture prevention
• 7:31
  - as a national
• 7:33
  - public health priority.
• 7:34
  - And that
• 7:36
  - will be done through this coordinated
• 7:38
  - awareness and education efforts that are going on.
• 7:42
  - Several organizations
• 7:43
  - within the OAN
• 7:44
  - have a broad reach among physicians and patients,
• 7:48
  - so we aim to use these platforms
• 7:51
  - to drive public awareness
• 7:53
  - on the risks of osteoporosis
• 7:55
  - and the importance
• 7:57
  - of secondary fracture prevention
• 7:59
  - across all of these channels.
• 8:02
  - Another key objective
• 8:04
  - is equipping clinicians to identify and treat high
• 8:07
  - risk patients through education,
• 8:10
  - knowledge
• 8:11
  - sharing, and practical tools
• 8:13
  - to support the post fracture care. I mean,
• 8:16
  - it is just absolutely astounding to me that
• 8:19
  - seven hundred and fifty thousand vertebral compression fractures
• 8:22
  - happen every year
• 8:24
  - in The United States, and yet most of
• 8:26
  - those are not recognized.
• 8:28
  - Most of them are not treated. So
• 8:30
  - driving the awareness of clinicians
• 8:33
  - to identify the osteoporosis
• 8:35
  - is is is huge in in our world,
• 8:38
  - in the spine lane, but also across
• 8:41
  - all of the specialties that are working together
• 8:43
  - in the OAN.
• 8:44
  - So the goal of our work is to
• 8:46
  - develop, again, practical,
• 8:48
  - clinician facing tools
• 8:50
  - to support the identification,
• 8:53
  - to support the diagnosis,
• 8:55
  - and to support treatment guidance
• 8:57
  - that can strengthen and standardize the guidelines in
• 9:00
  - osteoporosis care. And that includes
• 9:03
  - clarifying
• 9:05
  - ownership of the care after a diagnosis is
• 9:07
  - made,
• 9:08
  - and that is not a small
• 9:10
  - goal.
• 9:12
  - And then finally, our third objective is to
• 9:14
  - identify and address
• 9:16
  - knowledge gaps
• 9:17
  - that are impeding uptake of osteo related best
• 9:20
  - practices.
• 9:21
  - So we plan to work with our experts
• 9:23
  - across organizations
• 9:25
  - to identify health system gaps that keep osteoporosis
• 9:30
  - away from being prioritized
• 9:32
  - in public health so that we can propose
• 9:35
  - and adopt new care pathways
• 9:37
  - that can improve secondary prevention,
• 9:40
  - proper diagnosis,
• 9:41
  - and appropriate treatment for that osteoporosis.
• 9:45
  - Thanks, Rita.
• 9:47
  - We know there's a plethora of resources out
• 9:49
  - there that can help and guide
• 9:51
  - clinicians
• 9:53
  - to try and move this in the right
• 9:55
  - direction, not just in terms of awareness, but
• 9:57
  - putting putting that education
• 9:59
  - actually into urgent practice.
• 10:02
  - Susan,
• 10:02
  - talking about practice, I know you've started post
• 10:04
  - fracture care clinics in the past.
• 10:07
  - Could you speak a bit more to your
• 10:08
  - motivations behind doing so and also any practical
• 10:12
  - tips for listeners interested in starting their own?
• 10:15
  - Well, really post fracture, we want good outcomes
• 10:17
  - for our patients. We recognize this. Right? We're
• 10:20
  - doctors first.
• 10:21
  - We're excellent surgeons. We're doctors first, and we
• 10:25
  - want the best for our patients. And I'll
• 10:26
  - be honest with you, I started my career
• 10:29
  - in a pop in a, community that had
• 10:32
  - a very high elderly population,
• 10:34
  - and we took call a week at a
• 10:35
  - time. While I was doing my thirtieth or
• 10:37
  - thirty fifth hip fracture during that week,
• 10:40
  - I was begging to be able to do
• 10:42
  - elective surgery. Right? And we wanna make sure
• 10:45
  - that patients are not coming back again and
• 10:48
  - again and again with these fragility fractures.
• 10:51
  - Really, in starting the post fracture clinics,
• 10:55
  - the surgeons got it.
• 10:57
  - The systems
• 10:58
  - understood, but we were never really connecting the
• 11:01
  - dots. And and some of the practical things
• 11:03
  - now having been at three different institutions where
• 11:05
  - we've had to put this together, it's about
• 11:08
  - getting the system structure in place with a
• 11:11
  - physician champion,
• 11:12
  - with an advanced practitioner or a nurse or
• 11:15
  - a care coordinator who can really help to
• 11:17
  - move the patients through,
• 11:19
  - and getting that refined before expanding it out.
• 11:23
  - It's such a common problem that if you
• 11:25
  - try to do the boom all at once,
• 11:27
  - it becomes overwhelming, and that's where many systems
• 11:30
  - have failed. But if you get a group
• 11:32
  - together, whether it's in a private practice or
• 11:35
  - it's in a larger health system based or
• 11:37
  - an academic practice, you get a group together
• 11:40
  - that's smaller, you have that champion, you make
• 11:42
  - sure you have the resources,
• 11:43
  - you refine the billing, you refine the way
• 11:46
  - the patients are gonna get appointments, you refine
• 11:48
  - your order sets, you sort out some of
• 11:50
  - the challenges of your individual system as a
• 11:53
  - group for a year or so, and then
• 11:55
  - you expand it out. Those are the places
• 11:57
  - that have been very successful.
• 11:59
  - Thank you, Susan.
• 12:01
  - A lot of work, but it sounds like
• 12:02
  - finding that champion is the the key initiating
• 12:05
  - step.
• 12:06
  - To finish,
• 12:07
  - I'm gonna ask both our speakers. What can
• 12:09
  - listeners do today to take action and reduce
• 12:12
  - osteoporosis
• 12:13
  - related fracture risk? And Rita, I'll I'll start
• 12:16
  - with you.
• 12:17
  - Yeah. So
• 12:19
  - in osteoporosis
• 12:20
  - care,
• 12:21
  - we see that there is a lot of
• 12:23
  - confusion amongst patients.
• 12:25
  - There is misinformation
• 12:28
  - about
• 12:28
  - how to manage osteoporosis. There's all kinds of
• 12:32
  - products on the market that sell things to
• 12:34
  - patients, and
• 12:35
  - patients need a trusted, reliable place to go
• 12:39
  - to understand
• 12:40
  - bone health, what is bone health, what is
• 12:43
  - osteoporosis, and what do I do about it.
• 12:45
  - So I think that, you know, sort of
• 12:47
  - the number one thing we need to do
• 12:49
  - on the patient side is provide
• 12:52
  - education
• 12:53
  - that bone is a living, breathing organ in
• 12:56
  - your body that changes
• 12:58
  - throughout the day, throughout the week, throughout the
• 13:00
  - month, and that we must care for it
• 13:02
  - like any other organ in our body and
• 13:04
  - have reliable sources for that information.
• 13:08
  - And and that if you have a disease
• 13:10
  - in your bone,
• 13:12
  - that is okay.
• 13:13
  - There are treatments for it. And the treatments,
• 13:16
  - for the most part,
• 13:18
  - for most people,
• 13:20
  - are safe
• 13:21
  - and
• 13:22
  - efficacious.
• 13:23
  - So, you know, there is hesitancy
• 13:26
  - among
• 13:27
  - people
• 13:28
  - to take a medication. But if we explain
• 13:31
  - the benefits of taking a medicine,
• 13:34
  - then they are going to understand that it
• 13:36
  - is just as important as understanding
• 13:38
  - their cardiovascular
• 13:39
  - health. As an as a matter of fact,
• 13:42
  - you cannot have cardiovascular health if you cannot
• 13:46
  - move.
• 13:46
  - So really reframing the conversation,
• 13:50
  - having trusted sources for education for patients,
• 13:53
  - and and then
• 13:55
  - driving that awareness and that,
• 13:58
  - sort of demand from the patients that we
• 14:00
  - get better care
• 14:02
  - out there, that we don't allow these treatment
• 14:05
  - gaps to happen, I think, is one of
• 14:07
  - the most important things we can do. Thank
• 14:09
  - you, Rita. Susan?
• 14:11
  - Oh, Rita. I completely agree with you. And,
• 14:14
  - you know, really, for providers,
• 14:16
  - the best thing you can do, own it.
• 14:19
  - Right? The same way we can recite our
• 14:21
  - risk and benefits conversation when we talk about
• 14:23
  - consenting for surgery,
• 14:25
  - have that conversation ready and at your hand.
• 14:28
  - I am going to help you with this
• 14:29
  - problem with your spine. I'm going to help
• 14:32
  - you with this fracture,
• 14:33
  - and we are going to get you treated
• 14:36
  - for osteoporosis
• 14:37
  - because this fracture happened,
• 14:39
  - because you have the disease of osteoporosis.
• 14:42
  - Once you own it, then know your neighborhood.
• 14:45
  - Know where you can send the patient. Who's
• 14:47
  - taking care of it in your system right
• 14:49
  - now? Find that partner who can take care
• 14:51
  - of it. If that partner isn't there, how
• 14:54
  - do you create a structure? So at least
• 14:56
  - for your own patients, you can get them
• 14:58
  - into that structure and then build off of
• 15:01
  - that.
• 15:02
  - Work with your systems. Work with your specialty
• 15:05
  - societies.
• 15:06
  - How do you bill for these things? These
• 15:08
  - are things that are a part of patient
• 15:10
  - care.
• 15:11
  - And if you can put that system in
• 15:13
  - place, if your neighborhood doesn't have it, how
• 15:15
  - do you build that infrastructure in your neighborhood?
• 15:18
  - And really, it's about creating the team around
• 15:21
  - us to take comprehensive care of our patients
• 15:24
  - and recognizing this as that thing that is
• 15:27
  - going to put them in a nursing home,
• 15:29
  - stop them from driving, stop their pickleball, make
• 15:32
  - them have to use a walker.
• 15:34
  - Thanks, Susan. Before the podcast started, you and
• 15:36
  - I were talking a little bit about making
• 15:38
  - sure we're using the right vernacular for patients.
• 15:40
  - Just wondering if you wanted to touch on
• 15:43
  - the terminology that you use to help patients
• 15:45
  - understand this is not an old people's disease.
• 15:47
  - Right. Well, it's a it's a lifetime. It's
• 15:50
  - a health span. Right? So you build your
• 15:52
  - bone until you're 30, and then you slowly
• 15:55
  - lose it in mid age, and then both
• 15:57
  - men and women when they hit their early
• 15:59
  - fifties, women more so through menopause,
• 16:02
  - lose bone to up to two percent per
• 16:04
  - year over ten years.
• 16:06
  - This is a lifespan disease.
• 16:08
  - And instead of us talking about this as
• 16:11
  - in, you know, you have osteoporosis, this disease,
• 16:14
  - medicalizing it so much. When we talk to
• 16:16
  - patients about this, I'm trying to keep you
• 16:17
  - out of a nursing home. I'm trying to
• 16:19
  - keep you keep your human performance as optimal
• 16:22
  - as possible,
• 16:24
  - and that is the conversation.
• 16:26
  - It's not about trying to push medicines on
• 16:28
  - you. It's not about trying to tell you
• 16:30
  - that you're old. I'm actually
• 16:32
  - trying to help you with that longevity
• 16:35
  - conversation,
• 16:36
  - that health span conversation, that independence
• 16:38
  - conversation.
• 16:40
  - I love it. I can hear the passion
• 16:41
  - in your voice. And as a menopausal woman
• 16:43
  - myself,
• 16:44
  - I wanna live life according to my own
• 16:46
  - terms, so I really appreciate that. Well, time
• 16:49
  - has gone quick, so I wanted to thank
• 16:50
  - you both for sharing what the Osteoporosis
• 16:53
  - Action Network is with our listeners and its
• 16:56
  - mission.
• 16:57
  - I know you shared incredibly helpful
• 17:00
  - information for our listeners, not only to raise
• 17:02
  - awareness on osteoporosis,
• 17:04
  - but it's gonna take a village. Let's get
• 17:06
  - out there. Let's challenge each other to take
• 17:08
  - action and reduce the fracture
• 17:10
  - risk out there. And for those of you
• 17:13
  - looking for what those next steps are, visit
• 17:15
  - www.fracturehairgap.com.
• 17:19
  - This is a site where you can lead
• 17:21
  - to the society web pages and find a
• 17:23
  - logical flow of information that can really help
• 17:26
  - you. What does it mean to identify a
• 17:28
  - champion? What does it mean to be creating
• 17:30
  - those referral pathways?
• 17:32
  - What's needed for the EHR to really get
• 17:34
  - things optimized and help make your work less
• 17:37
  - and make sure we're doing the right thing
• 17:38
  - for patients.
• 17:40
  - So thank you so much to our speakers.
• 17:41
  - I really appreciated this discussion.
• 17:44
  - Thanks for having us. Thank you.
• 17:46
  - Thank you, Pinon, doctor Roy and doctor Burkata,
• 17:48
  - for this insightful conversation
• 17:50
  - on the Osteoporosis Action Network and the work
• 17:52
  - it is doing to reduce fracture risk. We
• 17:55
  - also want to thank our podcast sponsor, Amgen.
• 17:58
  - This episode is part of a four part
• 18:00
  - series sponsored by Amgen on post fracture osteoporosis
• 18:04
  - care. You can tune in to more podcasts
• 18:06
  - from Becker's Healthcare on post fracture care and
• 18:09
  - other topics by visiting the podcast page at
• 18:11
  - wwwbeckerspodcast.com.
• 18:14
  - Participants were compensated for their time by Amgen.