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TeleHealth and FRAX / Bone health patient screening

Algis V. Jovaisas, MD FRCPC

Algis V. Jovaisas, MD FRCPC Rheumatology Adjunct Professor of Medicine Department of Medicine Faculty of Medicine University of Ottawa Ottawa, Ontario.

  • Background

    Statement of Fact: 80% of patients leave the hospital on a beta-blocker after an MI 1 though only 15% of patients leave the hospital on osteoporosis treatment after a fragility fracture.2

    Fractures are to people with osteoporosis what heart attacks are to people with cardiovascular disease. Therefore, we must assess the risk of fracture in our patients with osteoporosis, just as patients with cardiovascular disease are assessed for risk of a cardiac event and treated accordingly. The goal of osteoporosis treatment is to reduce fractures in patients with osteoporosis.

    What is my patients’s risk of fracture?

    Tools like FRAX ® (Fracture Risk Assessment Tool) provide a conservative estimate of the 10-year fracture risk.3 The calculator takes in age, gender, bone mineral density (BMD), fracture history and other patient characteristics, such as smoking history, alcohol use, presence of rheumatoid arthritis, steroids use and any other causes of bone loss. The output is the 10-year risk of hip fracture or major osteoporotic fracture (MOF). The FRAX can also be done without inputting BMD, though the sensitivity is reduced somewhat.4

    Remember FRAX only starts the fracture risk assessment.

    Clinical assessment completes the risk assessment. Tools like FRAX have limitations5 that can be tempered with clinical judgement. In this post-pandemic era, we are doing more virtual visits with our patients. With virtual visits, we can still assess history of fragility fractures, existence of comorbid conditions, and fall risk. The in-person visit would be done when assessment of kyphosis, loss of height, rib to pelvis and occiput to wall measurements are needed.

  • About Expert

    Algis V. Jovaisas, MD FRCPC

    Dr. Jovaisas obtained his undergraduate bachelor's degree at the University of Guelph, followed by his undergraduate medical degree at the University of Toronto. His postgraduate training began at the University of Toronto, completing his internal medicine training at the University of Ottawa. Dr. Jovaisas completed his Rheumatology training also at the University of Ottawa.

    Current appointment is Adjunct Prof. of Medicine, Department of Medicine, Faculty of Medicine, University of Ottawa.

    Dr. Jovaisas is currently in full-time Private Practice Rheumatology, Medical Director and President of Capital North Therapeutics Research Inc. as well as Medical Director of Specialty Health Network Infusion Center.

    Dr. Jovaisas is Medical Lead for the Fracture Liaison Service-Ottawa. He is currently actively involved in teaching and development of education programs for Health Care Providers. His current research interests include osteoporosis, therapeutics in rheumatoid arthritis, other inflammatory diseases, osteoarthritis with many publications.

    He is currently a member of the Canadian Rheumatism Association, American Society of Bone and Mineral Research and was one of the founding members and first president of the Ontario Rheumatology Association as well as Past Chair Rheumatology Section-Ontario Medical Association.

  • References

    1. Bessette L, Ste-Marie L-G, Jean S, et al. The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporosis Int 2008;19:79-86.
    2. Austin PC, Tu JV, Ko DT, et al. Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction. CMAJ 2008;179:895-900
    3. Centre for Metabolic Bone Diseases. Fracture Risk Assessment Tool 2011. Available from: https://www.sheffield.ac.uk/FRAX/tool.aspx?country=19. Accessed 28 March 2022.
    4. Hoff M, Meyer HE, Skurtveit S, et al. Validation of FRAX and the impact of self-reported falls among elderly in a general population: the HUNT study, Norway. Osteoporosis Int 2017;28:2935-2944
    5. Kanis JA, McCloskey EV, Johansson H, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis Int 2013;24:23-57

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