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CME: Identifying and treating people at high risk for fracture from postmenopausal osteoporosis

Activity Description / Statement of Need:

In this online CME self-learning activity:

Osteoporosis is a disease common among elderly patients and is increasing in frequency as senior citizens begin to represent a larger share of the US population. In the US, fragility fractures are associated with 1.7 million hospitalizations, and the number of annual of osteoporotic fractures is expected to rise to three million annually in the next few years, with annual treatment costs expected to be $25.3 billion. Despite the morbidity and mortality associated with osteoporosis, practice gaps related to suboptimal screening, risk assessment, and management practices have led to underdiagnosis and undertreatment of this condition.

Osteoporosis screening may identify people at increased risk of low-trauma fracture who may benefit from interventions to minimize risk. The USPSTF recommends screening for osteoporosis with BMD testing in all women 65 years or older and in postmenopausal women younger than 65 years but at increased risk of osteoporosis. Risk for osteoporosis should be determined by a formal clinical measurement tool, such as FRAX™, which assesses 10-year fracture risk. Diagnosis of osteoporosis can be made based on the history of fragility fracture or with a T score of 2.5 SD or more below the young adult mean BMD.

However, the literature has consistently illustrated underutilization of screening and diagnostic measures. Clinicians should be aware that prior fragility fracture is sufficient for diagnosis of osteoporosis, and yet only one-quarter of patients with a prior fragility fracture were aware they had this condition. Underdiagnosis therefore represents a compelling safety consideration, as 20% of patients become dependent on long-term care after a hip fracture, and 20% die within a year from related complications. Because these outcomes represent significant quality and safety considerations, a number of national quality measures that are strongly supported by the evidence have been developed to address shortcomings in care. 

Target Audience:

HCPs specializing in endocrinology, internal medicine, geriatrics, and women’s health; physician assistants, nurse practitioners, and pharmacists who practice in those areas of specialty; and those who otherwise commonly care for or clinically encounter patients with postmenopausal osteoporosis.


Commercial Support Disclosure: This activity is supported by educational grants from Radius Health and Amgen.

Learners may participate in this activity free of charge.


Release Date: May 29, 2021 -- Expiration Date: May 29, 2023

Faculty: Stuart Silverman, MD

Agenda

Faculty introduction, disclosures

Introductory content: cursory refresher and review of postmenopausal osteoporosis

  • Epidemiology
  • Pathophysiology
    • Essential anatomy and structure of the bone
    • Causes and pathogenesis
  • Determinants of peak bone mass and the role of nutrition and vitamin D
  • Patient case(s)

Postmenopausal osteoporosis screening and risk assessment [Learning Objective #1]

  • BMD, dual-energy X-ray absorptiometry
  • Interpretation of T scores
  • WHO Fracture Risk Algorithm (FRAX)
  • Bone metabolic biomarkers and incorporation into clinical practice

Treatment of osteoporosis [Learning Objectives #2 & 3]

  • Determinants of candidates for treatment
  • Guidance for treatment: absolute thresholds vs. change in risk scores
  • Treatments: present and investigational
  • Anti-resorptives:
  • Bisphosphonates – safety
  • RANKL inhibitors: denosumab, romosozumab
  • Calcitonin
  • HRT/SERMs
  • Anabolics
  • Teriparatide, abaloparatide subcutaneous
  • Abaloparatide patch
  • Role of combination therapy
  • Tools to measure response to therapy
  • Length of therapy
  • Definition and role of quality measures and their incorporation into practice: MIPS, NCQA [Learning objective #4]
  • Other clinical pearls
  • Barriers to care: adherence, historically disadvantaged populations [Learning objective #5]
  • Patient case(s)

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Determine a given postmenopausal patient’s fracture risk using validated assessment tests.
  • Describe the relative efficacy and safety of presently available agents used to treat and prevent postmenopausal osteoporosis.
  • Formulate a treatment plan for a patient with postmenopausal osteoporosis at risk of fracture.
  • Recall quality measures aimed at osteoporosis treatment and fracture prevention and how to incorporate them into practice.
  • List barriers to care in the management of osteoporosis.

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CME-MOC_badge

ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

PhysiciansFor maintenance of certification (MOC) credit, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC credit for this activity. Please note: Not all activities on this site provide MOC credit. If this activity does not specify that it provides MOC credit in this section, then it does NOT provide MOC credit. This activity provides MOC credit only for ABIM.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 1.0 hours (0.1 CEUs) of continuing education.  Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE #0574-0000-21-014-H01-P. CPE credit effective 5/5/21 and expires 5/5/23.

This is a Application (A)-type activity.

Pharmacists: You must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.  ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure: Stuart Silverman, MD, FACP, FACR, Clinical Professor of Rheumatology, Cedars-Sinai and UCLA, has received financial compensation from Radius Health and Amgen from research grants, consulting, and/or speaker's bureau.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, President of ScientiaCME, has no relevant financial disclosures.
 
Commercial Support Disclosure: This activity is supported by educational grants from Radius Health and Amgen.

Instructions

  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version


Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.


Additional Courses That Are Related To This Activity

Postmenopausal osteoporosis risk stratification and treatment of those at high risk for fracture

Optimizing Primary and Secondary Fracture Prevention in Men with Osteoporosis

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Human papillomavirus: the rationale for prevention and optimizing vaccination strategies