Who manages osteoporosis?

Management of Osteoporosis: A Multidisciplinary Approach

Osteoporosis management requires coordination between multiple healthcare providers, with primary care physicians typically taking the lead role after initial diagnosis, especially as patients transition from active cancer treatment to long-term follow-up care. 1

Key Healthcare Providers in Osteoporosis Management

• Primary Care Physicians: Often serve as the main coordinator of osteoporosis care, especially after patients transition from active cancer treatment or specialty care 1, 2
• Oncologists: Typically manage bone health during active cancer treatment, particularly for patients receiving treatments that affect bone density (aromatase inhibitors, GnRH agonists) 1
• Endocrinologists: Often involved in complex cases or when secondary causes of osteoporosis need management 1, 3
• Rheumatologists: May manage patients with complex osteoporosis, especially those with comorbid rheumatologic conditions 3, 4
• Gynecologists: May manage osteoporosis in postmenopausal women, particularly when related to hormonal changes 1, 3
• Orthopedic Surgeons: Initially manage patients with fractures but should coordinate with other providers for long-term osteoporosis management 5

Coordination of Care Framework

During Active Cancer Treatment

• Bone health assessment and management typically falls under the primary oncology treatment team 1
• Initial screening, risk assessment, and treatment decisions are often made by oncologists for cancer patients 1
• Dental screening should be coordinated before initiating bone-modifying agents (BMAs) to reduce risk of osteonecrosis 1

Transition to Long-term Management

• As patients complete active cancer treatment, bone health management typically transitions to primary care physicians 1
• The timing of this transition should be determined individually based on patient needs and treatment status 1
• A treatment summary and individualized care plan should clearly identify the healthcare provider responsible for bone health 1

Role-Specific Responsibilities

• Primary Care Physicians:

  • Regular fracture risk assessment using validated tools like FRAX 3, 2
  • Ordering and interpreting bone mineral density tests 3, 4
  • Initiating first-line treatments for osteoporosis 2, 4
  • Coordinating lifestyle modifications and fall prevention strategies 3, 2

• Specialists (Endocrinologists, Rheumatologists):

  • Management of complex or treatment-resistant osteoporosis 3, 4
  • Prescribing and monitoring second-line therapies 6, 4
  • Addressing secondary causes of bone loss 3, 4

• Oncologists:

  • Monitoring bone health during cancer treatments known to affect bone density 1
  • Initiating preventive strategies for cancer treatment-induced bone loss 1

Common Pitfalls in Osteoporosis Management

• Fragmentation of Care: Lack of clear designation of which provider is responsible for bone health can lead to gaps in monitoring and treatment 1, 7
• Treatment Gaps: Despite diagnosis, many patients remain untreated or undertreated for osteoporosis 2, 7, 4
• Medication Concerns: Fear of rare side effects (like osteonecrosis of the jaw) may lead to inappropriate discontinuation of therapy 6, 7
• Inadequate Transition Planning: Failure to establish clear handoffs between oncology and primary care can result in discontinued monitoring 1

Best Practices for Coordinated Care

• Implement a formal clinical pathway for patients with osteoporosis or fragility fractures 5
• Develop a shared care plan that clearly designates responsibilities for bone health monitoring 1
• Utilize electronic health records to facilitate communication between providers 2
• Provide patient education about the importance of bone health and the roles of different providers 1, 5
• Schedule regular bone mineral density testing with clear follow-up plans 3, 4

By ensuring proper coordination between healthcare providers, patients with osteoporosis can receive comprehensive care that reduces fracture risk and improves quality of life 1, 2, 4.