Often silent and not sexy, why do I find osteoporosis so rewarding to manage?
Dr Jennifer Rogers discusses the importance of being able to effectively identify, treat and manage osteoporosis in the practice, and explains why GPs should include osteoporosis awareness in their PLANs.
After 33 years in general practice, I continue to enjoy “looking after my patients” although a lot of my energy is spent motivating them to look after themselves. One of the most challenging aspects of the specialty is to have a working knowledge across nearly all of the medical disciplines, as well as public health, health economics and coordinating care, despite working in a degree of isolation. Perhaps because of this, it also lends itself to developing areas of interest within one’s wider skill set. With that comes the satisfaction of being able to handle most presentations with confidence, a systematic approach and less need to refer. Our health system depends on GPs doing just this.
My interest in osteoporosis was piqued early in my career watching my aunt’s very intelligent, gentle friend spending her last months bedridden due to her propensity to fracture. She still had all her mental faculties but was trapped in a body that was crumbling. At that time we had little to offer her, let alone an understanding of bone metabolism. Unable to help, I actively sought out any new information and treatments and applied them as they became available. Today we can do something to markedly reduce the risk of fragility fracture. Anti-osteoporosis medications are effective and have side effects that pale into insignificance when compared with the much greater risk of loss of life, mobility and independence.
With our current knowledge, evidence-based treatments and the updated guidelines, now is a great time to become GOOD at “doing osteoporosis’’. Include osteoporosis awareness in your ‘PLAN’
As for all chronic disease, management is not just about doing the tests and prescribing the medications. There is a need to assess those most at risk and consider all of the other factors that contribute, such as falls. Empowering the individual and utilising other health providers is a vital part of management. If they don’t fall they are much less likely to fracture.
In general practice we develop these skills and treating osteoporosis fits the model ‘to a T’. The challenge is to look for and identify those at risk and start with lifestyle change and monitoring. Medication can be commenced when the risk has escalated. This includes the first fragility fracture (especially the silent morphometric vertebral ones) in an osteopenic person – as is the case 50% of the time. If truly at risk, medication should be continued in almost all cases.
With our current knowledge, evidence-based treatments and the updated guidelines, now is a great time to become GOOD at “doing osteoporosis’’. Include osteoporosis awareness in your ‘PLAN’ - you will be rewarded when one of your treated patients comes in after a rare fall and only has bruising or abrasions - or access further information via the Osteoporosis Australia website.
Jennifer J. Rogers MBBS (UWA), Dip Obs (RANZCOG)
Jenny is an experienced GP from the Northern suburbs of Perth. She enjoys the challenge of dealing with the many problems that present in general practice and has interests in osteoporosis, women's health, mental health, sports medicine, asthma and motivating lifestyle change in chronic disease management.