Can a patient with osteoporosis be excused from jury duty if it conflicts with her scheduled monthly injections for comprehensive osteoporosis treatment, such as denosumab (Prolia) or zoledronic acid (Reclast), over the next 10 months?

Medical Exemption for Jury Duty Due to Osteoporosis Treatment

A patient requiring monthly osteoporosis injections for a 10-month treatment period should be excused from jury duty if it conflicts with scheduled medical appointments, as interruption of this therapy could significantly increase fracture risk and negatively impact mortality and quality of life outcomes.

Medical Necessity of Consistent Osteoporosis Treatment

Treatment Regimens and Adherence

Osteoporosis treatments that require monthly administration typically include:

• Denosumab (Prolia): Administered subcutaneously every 6 months
• Zoledronic acid (Reclast): Administered intravenously once yearly
• Monthly bisphosphonate injections: Some formulations require monthly administration

The efficacy of these medications depends critically on adherence to the prescribed schedule:

• Poor adherence to osteoporosis medications is extremely common, with studies showing that approximately 75% of women become non-adherent within 12 months of starting therapy, and almost 50% discontinue treatment entirely within this timeframe 1
• Interruption of denosumab therapy is particularly problematic as it is not stored in bone, and its effects diminish quickly after discontinuation 2
• Unlike bisphosphonates, denosumab requires continuous therapy to maintain its anti-fracture benefits 2

Clinical Consequences of Treatment Interruption

Interrupting osteoporosis treatment can lead to:

1. Rapid bone loss, particularly with denosumab discontinuation
2. Increased risk of vertebral and hip fractures
3. Higher mortality risk (hip fractures carry a 20-30% one-year mortality rate)
4. Decreased quality of life due to pain, disability, and loss of independence

Guidelines Supporting Consistent Treatment

The American College of Physicians (ACP) guidelines recommend:

• Pharmacologic treatment with alendronate, risedronate, zoledronic acid, or denosumab to reduce fracture risk in women with known osteoporosis 2
• Treatment for at least 5 years to achieve optimal benefits 2

ESMO guidelines emphasize:

• The pharmacokinetics of denosumab make it particularly unsuitable for intermittent treatment 2
• Based on its pharmacodynamics, denosumab for bone disease requires continuous monthly therapy 2

Practical Considerations for Jury Duty Exemption

Documentation Requirements

The patient should obtain:

1. A detailed medical note specifying:

   • Diagnosis of osteoporosis
   • Treatment regimen requiring monthly appointments for 10 months
   • Medical necessity of maintaining the treatment schedule
   • Potential health consequences of treatment interruption

2. Specific appointment dates for the next 10 months

Alternative Arrangements

If complete exemption is not possible:

• Request scheduling accommodations that work around treatment appointments
• Ask for a deferral of jury service until after completion of the 10-month treatment period

Conclusion

Given the significant health risks associated with interrupting osteoporosis treatment, particularly with medications like denosumab that require strict adherence to dosing schedules, medical exemption from jury duty is appropriate when service would interfere with scheduled treatments. The potential consequences of treatment interruption—including increased fracture risk, hospitalization, disability, and mortality—justify prioritizing the patient's medical care over jury service obligations.