Don't let the exam break you: Osteoporosis
EXAM STUDY TIPS
If you’re asked on the Family Medicine exam how you’d manage a patient with osteoporosis, don’t forget to include all of the non-medical treatments. As you’ll learn in The Review Course, MANAGEMENT = MORE THAN MEDICATION.
To get extra marks on the exam beyond just the current medical options for treatment of osteoporosis, be sure to consider how you might incorporate this into any scenario and for any exam question.
How would this change what you do on an exam? Think of a scenario where you are interviewing a patient who presents with questions about their own risk for osteoporosis.
What NOT to do: Don’t just request a bone mineral density and tell them you’ll follow up with the result. Also, don't recommend intranasal calcitonin - remember it's no longer on the market! The injectable version still is, however.
To get some extra marks, remember that the most recent Canadian guidelines on Osteoporosis recommend every patient should be counselled on lifestyle measures – even patients who are low risk. Guideline-based care recommends that everyone is counselled on the following lifestyle modifications (if you like mnemonics, think CCDEF):
C - Calcium
C - Cigarettes (smoking cessation)
D - Vitamin D
E - Exercise
F - Falls Prevention
If you or a resident you know are still thinking about signing up for The Review Course, don't forget our early bird discount ends in just a few weeks - sign up now!
PEARLS FOR PRACTICE
I recently had a patient who confided in me just how stressful it was to take time off of work for medical appointments. “I really can’t take another day off work. My boss isn’t happy with me missing work, and besides, I need the money and I don’t get paid when I’m not there.”
Just like in the exam scenarios, in clinical practice you’ll find that often you have to take into context the patient and their preferences, rather than simply following the guidelines. For a patient like this gentleman, taking a day off of work to sit in a radiology department and get a BMD may be excessively burdensome. If he’s low risk for a fragility fracture, the best plan for him may end up screening him based on other tools – instead of the BMD.
It can be perfectly acceptable to decide which of your patients to screen (or even treat) for osteoporosis using a tool other than BMD.
FRAX One of the more popular tools, developed by the WHO. Be sure to choose CANADA. Does NOT require a BMD.
OST (Osteoporosis Screening Tool) = Age - Weight in Kg The simplest tool available, and just as effective as other tools.* If OST score is greater than -5 the patient is high risk; BMD should be considered. It has been validated in many races; for Asian patients use a cutoff of >5.
ORAI, OSIRIS, SCORE, Age Multiple other screening tools, with varying degrees of complexity.
Bonus tip: Consider setting up a Calculators folder in your office web browser's Bookmarks, so you can easily access these while you are counselling a patient in your office.
Every tool (including BMD) has its limitations, and one of the challenges – and most rewarding aspects – of Family Practice is the opportunity to come up with creative and individualized ways to overcome these challenges for your specific patients.