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Consult with osteoporosis experts as they challenge your knowledge and provide practical case-based advice. Each 15-minute session is accessible wherever you go, whenever you're ready.
Click on each case below to choose your participation format.
Formats available are:
- Listen to the Podcast (Instructions & more information)
- Download the Podcast as an MP3 file (Instructions & more information)
- Listen to the Podcast and View the accompanying slide presentation
After you have completed your participation, please return to this page to get your certificate.
Target Audience
This educational program was developed for primary care physicians, obstetricians, gynecologists, and other healthcare professionals, who treat patients at risk for osteoporosis.
CME Accreditation
The Potomac Center for Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Designation Statement
The Potomac Center for Medical Education designates each educational activity for a maximum of .25 AMA PRA Category I credit(s)™ per webcast. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Physicians have the opportunity to earn up to 3 AMA PRA Category I credit(s)™ by completing the series.
Disclosure Policy
Potomac Center for Medical Education (PCME) adheres to guidelines of the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous.
All faculty in a position to control the content of a continuing medical education program sponsored by the Potomac Center for Medical Education are required to disclose any relevant financial relationships with any commercial interest. All conflicts are identified and resolved by PCME in advance of delivery of the activity to learners.
Case 01 Overview
Osteoporosis in men is under diagnosed and under treated. One of the biggest reasons for this is the perception that it is only a disease of women. About 1-2 million American men have osteoporosis and 8-13 million have low bone density. Around 30% of all osteoporotic fractures occur in men, and their incidence of osteoporotic hip and spine fractures increase exponentially after age 65. Men have worse post-fracture outcomes than women. The fracture burden of illness in men could be attenuated by increasing awareness of the problem and performing fracture risk assessment in men at risk.
Consult 01a: Meet Robert M.
He's 65 years old, 5' 8" tall and weighs 165 lbs. He's been complaining of mid thoracic discomfort and his elderly mother has finally convinced him to see his doctor.
Consult 01b: Meet Eleanor M.
She's 63 years old, weighs 119 lbs., and smokes a half a pack of cigarettes per day. She is worried about the fact that her driver's license lists her height at 5' 5", but she now stands at 5' 3". With a family history of osteoporosis, and a femoral neck T-score of -2.2, she has every right to be concerned. Learn what therapeutic choices Eleanor has, and discover what her physician prescribes in the second part of this 3-part CME case study.
Consult 01c: Meet Margaret M.
Margaret us an 83-year-old woman whose son and daughter both have osteoporosis. She has been on treatment with bisphosphonate for 9 years with good results. She was started on therapy due to 2 compression fractures of her vertebrea which were asymptomatic, as they usually are. Her card-playing buddies have told her that they've stopped taking their medications, and she should do the same. What can you tell her about this?
Learning Objectives
At the conclusion of this activity participants should be able to:
- Describe the epidemiology and etiology of osteoporosis in men
- Define the role family history plays in determining the risk of osteoporosis
- Explain the role of bone mineral density testing in diagnosing osteoporosis
- Identify the pharmacologic interventions available and the advantages and disadvantages of each
- Cite the safety and efficacy profiles of bisphosphonate therapies
Faculty
M. Susan Burke, MD, FACP
Clinical Assistant Professor of Medicine
Thomas Jefferson University Medical School
Philadelphia, PA
M. Susan Burke, MD, FACP received her bachelor's in biology from Chestnut Hill College in Philadelphia, PA. She graduated from the University of Pennsylvania School of Medicine in 1979 and completed a residency in internal medicine at Lankenau Hospital in Wynnewood, PA in 1982. Since then, Dr. Burke has been Director of the Lankenau Internal Medicine Clinical Care Center. She is also Clinical Assistant Professor of Medicine at Thomas Jefferson University in Philadelphia, is board certified in internal medicine and geriatrics, and is a Fellow of the American College of Physicians.
Dr. Burke is a two-time recipient of the Osler-Blockley Award from Thomas Jefferson University for excellence in teaching medicine at the bedside, and has also received the residents' award for best teacher from the Lankenau Internal Medicine house staff. She was recently named "Top Doctor for Women" by Main Line Today magazine. Dr. Burke lectures frequently and has published chapters, articles and CD-ROMs on numerous primary care and geriatric topics. Dr. Burke holds memberships in several professional societies, including the American Medical Association, American Geriatric Society, National Osteoporosis Foundation, American College of Physicians, International Society for Clinical Densitometry, and American Society for Bone and Mineral Research.
Disclosure Statement
Potomac Center for Medical Education (PCME) adheres to guidelines of the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All faculty in a position to control the content of a continuing medical education program sponsored by the Potomac Center for Medical Education are required to disclose any relevant financial relationships with any commercial interest. All conflicts are identified and resolved by PCME in advance of delivery of the activity to learners.
Faculty Disclosure
M. Susan Burke, MD, FACP
Speaker's Bureau:
- GlaxoSmithKline
- Merck
Case 02 Overview
Each year approximately 1.5 million Americans suffer an osteoporotic fracture. This series of podcasts focuses on diagnostic strategies and assessment of risk of osteoporotic fracture, as well as the relationship of bone turnover, age, and BMD to fracture risk. Information will also be provided on vitamin D and calcium in neuromuscular and bone health. Then we will examine the case of Helen K., an elderly woman with symptoms of osteoporosis.
Meet Helen K.
She's a 71-year-old Caucasian woman with controlled high blood pressure. Menopausal at 52, Helen took hormones for 14 years. Her mother, who died at 75, had breast cancer and a dowager's hump. Helen currently weighs 140 lbs. and recently lost an inch and a half in height. She has cataracts. In Case 2 we'll diagnose Helen's condition, discuss treatment options, and investigate preventive measures to reduce her risk of fracture.
Learning Objectives
At the conclusion of this activity participants should be able to:
- Describe the roles of calcium and vitamin D in bone health
- Recognize preventive measures to reduce fracture risk
- Define Absolute Fracture Risk and discuss its potential use in clinical practice
Faculty
Neil Binkley, MD
Associate Professor
University of Wisconsin
Madison, WI
Neil Binkley, MD earned his medical degree from the University of Wisconsin Medical School and subsequently received his training in internal medicine at the Marshfield Clinic. After several years in private practice, he returned to the University of Wisconsin in 1990 and completed a geriatric fellowship. Dr. Binkley is board certified in internal medicine and geriatrics. In 1994, he established the University of Wisconsin Osteoporosis Clinical Center and Research Program. He is an Associate Professor of Endocrinology and Geriatrics at the University of Wisconsin and Associate Director of the University of Wisconsin Institute on Aging. He is currently Past-President of the International Society for Clinical Densitometry and chaired their 2005 Position Development Conference.
His research efforts focus on osteoporosis diagnosis, osteoporosis in men, and the role of nutrition in bone loss. He has published over 80 articles in the peer-reviewed literature, contributed to numerous textbooks, and has authored over 140 abstracts. He is a member of the American Geriatrics Society, American Society for Bone and Mineral Research, American Association of Clinical Endocrinologists, International Society for Clinical Densitometry, Gerontological Society of America, International Bone and Mineral Society, and the Wisconsin Bone Club.
Disclosure Statement
Potomac Center for Medical Education (PCME) adheres to guidelines of the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All faculty in a position to control the content of a continuing medical education program sponsored by the Potomac Center for Medical Education are required to disclose any relevant financial relationships with any commercial interest. All conflicts are identified and resolved by PCME in advance of delivery of the activity to learners.
Faculty Disclosure
Neil Binkley, MD
Research Support:
- Aventis
- Eisai
- Merck
- Mission Pharmacal
- Novartis
- Pfizer
- Roche
Speakers Bureau:
- Merck
- Proctor & Gamble Pharmaceuticals
- Roche
Consultant:
- Merck
- Novartis
Case 03 Overview
The female athlete triad is the combination of three interrelated conditions disordered eating, amenorrhea and osteoporosis. Accurate prevalence determination is difficult as some components of the triad may be undetected. The lost in bone mineral density due to hormonal changes and nutritional deficiency increases the risk for fracture at a time the individual should have reached peak bone mass. Long term consequences can be devastating for the young female athlete.
Meet Nicole S.
She's a 19 Year Old Collegiate Long Distance Runner presenting with six month duration of anterior lower left leg pain. Nicole's height is 5'9" and her weight is 122lbs (down 10lbs since her freshman year).ÊShe has been running since she was 15 years old and has reported irregular menstruation cycles every 5-6 months since age 16.ÊSelf reported diet is good. Her anterior lower left leg pain has not kept her from running.
In Cases B and C we'll meet and diagnose Nicole's younger 16 year old sister.ÊShe is still without menses, and because of family pressure, exercises a rigorously. Additionally, she admits to dietary restrictions.
Learning Objectives
At the conclusion of this activity participants should be able to:
- Describe the epidemiology and etiology of osteoporosis in men
- Define the role family history plays in determining the risk of osteoporosis
- Explain the role of bone mineral density testing in diagnosing osteoporosis
- Identify the pharmacologic interventions available and the advantages and disadvantages of each
- Cite the safety and efficacy profiles of bisphosphonate therapies
Faculty
Ruby Huttner, MD, FACOG
Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences
Robert Wood Johnson School of Medicine
Piscataway, NJ
Ruby Huttner, MD, FACOG is a graduate of Princeton University with a BA in biology. He obtained his medical degree from the University of Rochester, School of Medicine and Dentistry. He completed his residency specializing in obstetrics and gynecology at the University of Pennsylvania.
Dr. Huttner is a board certified member of the American College of Obstetricians and Gynecologists. He is the former Chairman of Obstetrics and Gynecology at the Hunterdon Medical Center and is an active member of the American Medical Association, American Fertility Society, American Institute of Ultrasound in Medicine, and International Society of Clinical Densitometry.
Dr. Huttner's special interests include fertility and perimenopausal patients. He lectures widely on these topics and women's health issues such as osteoporosis. He was recently appointed as a Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School.
Disclosure Statement
Potomac Center for Medical Education (PCME) adheres to guidelines of the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All faculty in a position to control the content of a continuing medical education program sponsored by the Potomac Center for Medical Education are required to disclose any relevant financial relationships with any commercial interest. All conflicts are identified and resolved by PCME in advance of delivery of the activity to learners.
Faculty Disclosure
Ruby Huttner, MD, FACOG
Research Support:
- Aventis
- Eisai
- GSK
- Merck
- Mission Pharmacal
- Novartis
- Pfizer
- Roche
Speakers Bureau:
- Merck
- Proctor & Gamble Pharmaceuticals
- Roche
Consultant:
- Merck
- Novartis
- Lilly
Case 04 Overview
Glucocorticoids are widely used to treat a number of inflammatory and autoimmune conditions, including asthma, chronic obstructive pulmonary disease, rheumatoid arthritis, and inflammatory bowel disease. Glucocorticoid users are at increased risk for bone loss, due to the direct effects of steroids on bone formation and resorption and bone structure, and also because of their underlying condition. As a result, the prevalence of fractures in glucocorticoid users is high, averaging 30Ð50%. Prophylactic strategies exist and should be initiated in all patients starting or undergoing glucocorticoid therapy.
Meet Clara J.
Clara is 5'1" and she weighs 123lbs. She's a 36-year-old with a history of chronic polyarticular rheumatoid arthritis. Clara has been diagnosed with mild osteopenia, and her mother also had rheumatoid arthritis. Ten days after giving birth to her third child, Clara experienced a generalized flare in her arthritis. To control this, she was prescribed 15 mg/day of prednisone, which was expected to be taken for several months.
In Consult 4a, we'll discuss the pathogenesis of glucocorticosteroid-induced osteoporosis (GIOP) and how it usually presents. We will also explore the roles of rheumatoid arthritis, asthma, inflammatory bowel disease, systemic lupus erythematosus, and chronic obstructive pulmonary disease in the development of GIOP.
In Consult 4b, we will explore the fracture risk associated with glucocorticosteroid-induced osteoporosis, and look at the guidelines for DXA measurement when dealing with this condition.
Consult 4c discusses the prevention of glucocorticosteroid-induced osteoporosis. We will examine treatment options, both pharmacologic and non-pharmacologic, and what therapeutic regimen might work best for Clara.
Learning Objectives
At the conclusion of this activity participants should be able to:
- Review the 2001 American College of Rheumatology recommendations for the prevention of steroid-induced osteoporosis and compare these with the 2005 evidence-based guidelines from the Belgian Bone Club
- Explain at least two pathways by which steroid intake can lead to bone loss
- Cite two lifestyle interventions that can reduce risk for bone loss
- Name two pharmacologic interventions to reduce risk for steroid-induced osteoporosis
Faculty
Warren A. Katz, MD, FACP, FACR
Rheumatology
Rothman Institute of Orthopaedics
Philadelphia, PA
Warren A. Katz, MD, FACP, FACR, of the Rothman Institute of Orthopaedics in Philadelphia, PA, is President of CampHealthUSA, an educational initiative, and Executive Vice President for Corporate Medical Affairs of ETHOS Health Communications, a national medical education consulting firm. Dr. Katz also serves as Clinical Professor of Medicine at the University of Pennsylvania School of Medicine, where he was Chief of Rheumatology for more than 16 years and Chairman of Medicine for more than 11 years at the University of Pennsylvania Health System/Presbyterian Medical Center.
Dr. Katz received his medical degree from Jefferson Medical College in Philadelphia, PA. He completed his internship at Albert Einstein Medical Center in Philadelphia, PA and then went on to take residencies in medicine at Boston City Hospital in Boston, MA and Mt. Sinai Hospital in New York, NY. Dr. Katz is board-certified in both internal medicine and rheumatology. He has written numerous articles, book chapters, abstracts, and Internet programs, and has lectured internationally on the topics of rheumatology, osteoporosis, and musculoskeletal pain management.
Dr. Katz is the author of two editions of Diagnosis and Management of Rheumatic Diseases (Lippincott) and Pain Management in Rheumatologic Disorders: A Guide for Clinicians (Drugsmartz Pub). He has served on the editorial boards or as a reviewer for several medical journals, including Annals of Internal Medicine, Seminars in Integrative Medicine and Journal of Rheumatology. He was also Section Editor for an issue of Current Opinion in Rheumatology.
Dr. Katz is Director of the Osteoporosis Center, at the Rothman Institute's King of Prussia, PA location. A member of several medical societies, he is Past President of the Philadelphia Rheumatism Society and a life-fellow of the American College of Physicians and the American College of Rheumatology. In addition to being a longstanding member of both the Philadelphia County and Pennsylvania medical societies, he is a trustee of the College of Physicians of Philadelphia, where he also serves on the Executive Committee and is chairman of the Admissions Committee.
Dr. Katz's many accolades include the prestigious Dr. Joseph Lee Hollander Award for Excellence and Achievement in Rheumatology, presented by the Eastern Pennsylvania Chapter of the Arthritis Foundation. He has been recognized as a "Best Doctor" by Philadelphia, Town & Country, and Best Doctors in America. He has been listed in Who's Who in Science, Who's Who in America, and Who's Who in the World.
Disclosure Statement
Potomac Center for Medical Education (PCME) adheres to guidelines of the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All faculty in a position to control the content of a continuing medical education program sponsored by the Potomac Center for Medical Education are required to disclose any relevant financial relationships with any commercial interest. All conflicts are identified and resolved by PCME in advance of delivery of the activity to learners.
Faculty Disclosure
Warren A. Katz, MD, FACP, FACR
Speaker:
- Merck
- Pricara
Consultant
- Ethos Healthcare
