Osteoporosis Treatment Crisis - Teamwork Required
Musculoskeletal diseases are among the most common conditions affecting all of mankind and remain major sources of pain, disability and loss of productivity. The personal and societal costs of these conditions are enormous as well documented in BMUS (Burden of Musculoskeletal Diseases in the United States), a superbly researched and annotated data resource. The statistics are striking. To cite a few examples: arthritis and back pain affect almost 2 billion people worldwide, rank second as causes of disability and rank fourth in terms of their effect on the overall health of the population. Furthermore, with the aging of the populations, these numbers will only grow.
While the evidence for the impact of musculoskeletal disease is incontrovertible, nevertheless, there are significant gaps in care and these conditions often do not receive the same attention at the national level as do other chronic and prevalent diseases such as heart disease, cancer and stroke. As President of the United States Bone and Joint Initiative (USBJI), I wonder about this situation and what the USBJI can do to increase awareness, facilitate both public and professional education and advance the research agenda to achieve more effective and personalized patient-centric care.
An important feature of musculoskeletal care is its multidisciplinary nature. Patient management often involves teams, often with quite a few members, each of whom bring to bear important skills and expertise to achieve optimal results. When the team functions well, the patient is the winner. Unfortunately, many patients do not receive such multidisciplinary care since, in a given locale or health care system, a full team cannot be assembled or coordinated. Payment can also be an issue if there is inadequate reimbursement for one of the team member’s contribution.
Another issue in achieving optimal patient management concerns the identity of team members. Consider the situation of osteoporosis. As well documented, osteoporosis care is lagging despite impressive advances in drug therapy and the recognition of the importance of diet and exercise. In the setting of hip fracture, for example, only a small percentage of patients who should receive treatment with bisphosphonates or other agents actually are started on such agents despite data on clinical and even survival benefits. The data on fracture prevention are equally troubling as treatment of post-menopausal osteoporosis lags and the decreases in hip fracture levels off.
While concern over certain serious albeit rare side effects may limit prescription or patient acceptance or compliance with bisphosphonates and other anti-resorptive therapies, that is unlikely the entire story. One issue that may be limiting osteoporosis care is uncertainty about who is on the team or, perhaps, more appropriately who is the captain of the team. Osteoporosis care can be part of the practice of, among others, general internists, rheumatologists, endocrinologists and gynecologists depending on local practice patterns. For the setting of hip fracture, the orthopedist is clearly a member of the team involved with surgical repair but what is the role in the future in treatment of osteoporosis to prevent recurrence?
Some practitioners have a special interest in osteoporosis and make it a major focus of their clinical activities. For most others, it is one of many conditions that occupy their attention. I doubt that it is number 1 for any and it is more likely somewhere down on the list. That can be a serious problem given the understanding and experience needed to diagnose osteoporosis and use currently available therapy.
The situation, however, is also an opportunity for the USBJI to play a major role in improving care and, as an organization, I think that we should become leaders. By its nature, the USBJI is a multidisciplinary organization of organizations that seeks to build alliances among its members by increasing communication and interaction and sitting down at the same table to identify problems and work toward solutions. I am very pleased by the role of the USBJI in addressing the crisis in osteoporosis care and working with other organizations to assure that patients receive the benefits that current therapy affords.
The treatment of osteoporosis is but one area that members of the USBJI are discussing and working together on innovative programs for public and professional education as well as advocacy. Early inflammatory disease is another which I will discuss in a coming editorial. I am excited that an organization of organizations can have an important voice in improving care.
There is a famous expression about preaching to the choir. In the case of musculoskeletal disease, I think that the choir with its many voices may actually do better at the preaching than a single voice. I look forward to working together with constituent members and I hope that as many as possible will do some preaching on the treatment of osteoporosis.
Organizations are invited to become signatories of the Call to Action to Action to Address the Crisis in the Treatment of Osteoporosis. The USBJI is a signatory. Click here to view the Call to Action. If your organization wishes to become a signatory, please email aelderkin@asbmr.org
