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Lessons learned with Bone Health TeleECHO: making treatment decisions when guidelines conflict

  • Concise Clinical Review
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Abstract

Clinical practice guidelines provide helpful information for managing patients with metabolic bone disease. Good guidelines are based on the best available medical evidence; however, guidelines from different societies can conflict. Additionally, it is not possible for a guideline to anticipate the vast variability of circumstances, comorbidities, previous medical experiences, cultural differences, and preferences in real-world patients. Bone Health TeleECHO is a strategy for sharing knowledge on the care of patients with skeletal diseases through ongoing interactive videoconferences. We report three cases based on those presented at Bone Health TeleECHO, where, through discussion, treatment outside of commonly used guidelines was ultimately recommended. Guidelines developed by different organizations may provide “evidence-based” or “informed” recommendations which do not account for the variability of clinical circumstances encountered in the care of individual patients. This highlights the importance of Bone Health TeleECHO, where healthcare professionals can share knowledge, individualize treatment decisions, and improve patient care.

Learning objectives

At the end of this activity participants should be able to:

• Distinguish between the onset and off of bisphosphonates versus other medications used in the prevention and treatment of osteoporosis and how this affects choice of a “drug holiday.”

• Understand the limitations of clinical practices guidelines in the care of an individual patient and how interactive video conferencing can assist with decision making.

• Recognize that patients treated with glucocorticoids at high risk for fracture can benefit from more aggressive interventions for osteoporosis.

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Author information

Authors and Affiliations

  1. Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA

    M. S. Rothman

  2. Department of Rheumatology, Geisinger Medical Center, Danville, PA, USA

    T. P. Olenginski

  3. Colorado Center for Bone Research at Panorama Orthopedics and Spine Center, Golden, CO, USA

    I. Stanciu

  4. The CORE Institute Phoenix, Phoenix, AZ, USA

    K. Krohn

  5. New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA

    E. M. Lewiecki

Authors
  1. M. S. Rothman
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  2. T. P. Olenginski
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  3. I. Stanciu
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  4. K. Krohn
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  5. E. M. Lewiecki
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Corresponding author

Correspondence to M. S. Rothman.

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Conflict of interest

MSR has nothing to disclose.

TPO is a consultant and serves on a speakers’ bureau for Amgen and Radius.

IS has received no direct income from potentially conflicting entities. Her employer Panorama Orthopedics and Spine Center receives research grants from Alexion, Amgen, Radius Health, and Regeneron. She serves on a speakers’ bureau for Radius Health.

KK is a speaker and consultant to Radius and has a retirement pension from Eli Lilly.

EML has received no direct income from potentially conflicting entities. His employer, New Mexico Clinical Research & Osteoporosis Center, has received research grants from Radius, Amgen, Mereo, Bindex; income for service on scientific advisory boards or consulting for Amgen, Radius, Alexion, Sandoz, Samsung Bioepis; service on speakers’ bureaus for Radius, Alexion; project development for the University of New Mexico; and royalties from UpToDate for sections on DXA, fracture risk assessment, and prevention of osteoporosis. He is a board member of the National Osteoporosis Foundation, International Society for Clinical Densitometry, and Osteoporosis Foundation of New Mexico.

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Rothman, M.S., Olenginski, T.P., Stanciu, I. et al. Lessons learned with Bone Health TeleECHO: making treatment decisions when guidelines conflict. Osteoporos Int 30, 2401–2406 (2019). https://doi.org/10.1007/s00198-019-05147-8

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  • DOI: https://doi.org/10.1007/s00198-019-05147-8

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