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Please complete the question.

Hypothetical patient

Mrs Flava aged 74 years

Asthma and COPD diagnosed aged 58 years — long-term inhaled corticosteroid plus long-acting beta2-agonist use required, oral corticosteroids used periodically to control flare-ups of COPD.
Smoker — 38 pack-year history.
Type 2 diabetes diagnosed 10 years ago — treated with metformin/gliptin fixed-dose combination, most recent HbA1c 7.8%.

Scenario 1

Reason for encounter: “Doctor I am visiting today for a repeat prescription for my inhaler.”

In addition to Mrs Flava’s repeat prescription, which (if any) of the following comorbidities would you consider serious and urgent enough to discuss with Mrs Flava in this consultation?

Asthma

COPD

Smoking

Diabetes

Osteoporosis

Other

Scenario 2

Reason for encounter: “Doctor I have seen some information about bowel cancer and I am wondering whether I need to get checked?”

In addition to discussing bowel cancer screening, which (if any) of the following comorbidities would you consider serious and urgent enough to discuss with Mrs Flava in this consultation?

Asthma

COPD

Smoking

Diabetes

Osteoporosis

Other

All fields highlighted are mandatory.

Hypothetical patient

Mrs Bambinetti aged 61 years

Anxiety disorder diagnosed 10 years ago, recently ceased her SSRI and is using CBT.
Atrial fibrillation diagnosed 4 years ago - treated with non-Vitamin K antagonist oral anticoagulant.
Chest X-ray taken following a recent bout of pneumonia: Radiologist reports 2 moderate wedge fractures at T7, T8. She reports no history of trauma.

Scenario 1

Reason for encounter: “Doctor, I finished my antibiotics for my pneumonia a week ago and you asked me to come back for a follow-up appointment.”

In addition to assessing Mrs Bambinetti’s pneumonia recovery, which (if any) of the following comorbidities would you consider serious and urgent enough to discuss with Mrs Bambinetti in this consultation?

Anxiety

Atrial fibrillation

Lung disease

Osteoporosis

Other

Scenario 2

Reason for encounter: “Doctor, I have come in today for my annual flu shot.”

In addition to Mrs Bambinetti’s flu shot, which (if any) of the following comorbidities would you consider serious and urgent enough to discuss with Mrs Bambinetti in this consultation?

Anxiety

Atrial fibrillation

Lung disease

Osteoporosis

Other

All fields highlighted are mandatory.

Mrs Varga aged 81 years

Screening DEXA test results BMD T-score lumbar spine –2.2, femoral neck –1.9.

Would you initiate antiresorptive treatment?

Mrs Armstrong aged 68 years

DEXA ordered after she recently broke her wrist in a fall after tripping over her cat in the lounge room. BMD T-score lumbar spine –2.6, femoral neck –1.9.

Would you initiate antiresorptive treatment?

Mr Khan aged 73 years

25 pack-year smoking history, mild COPD. Recent DEXA results BMD T-score lumbar spine –2.9, femoral neck –2.3.

Would you initiate antiresorptive treatment?

Mrs Mori aged 68 years

DEXA ordered following X-ray showing 3 moderate vertebral crush fractures BMD T-score lumbar spine –2.1, femoral neck –1.8

Would you initiate antiresorptive treatment?

All fields highlighted are mandatory.

Success.

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What comorbidities does patient have?

What additional risk factors for osteoporosis does this patient have?

Have you prioritised an investigation of osteoporosis in this patient?

Yes

Please provide your rationale for testing or not testing

All fields highlighted are mandatory.

Please enter at least 2 patients.

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What fracture did this patient sustain and when (fracture to have occurred within the last 12 months)?

Did you refer this patient for a DEXA? If yes, what were the results?

Yes

Would you diagnose this patient with osteoporosis?

Yes

What is your reason?

The PBS considers a minimal trauma fracture to indicate a presumptive diagnosis of osteoporosis making the patient appropriate for treatment (without the requirement of a BMD report).

Do you consider the risk of subsequent fracture for this patient serious and urgent enough to instigate treatment?

Yes

All fields highlighted are mandatory.

Please enter at least 2 patients.

Success.

Patient 1

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Patient 2

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Patient 3

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Date that this patient received a diagnosis of osteoporosis?

What was the basis of their diagnosis? (minimal trauma fracture or DEXA results)

Date of last consultation with your surgery / or date patient received a repeat script for their anti-osteoporosis medication?

Is there a valid reason this patient has not received a repeat script for their anti-osteoporosis medication within the last 12-months?

Yes

Unknown

Do you consider the risk of subsequent fracture for this patient serious and urgent enough to recall them for a review of treatment?

Yes

All fields highlighted are mandatory.

Please enter at least 6 patients.

Success.

Patients aged over 70 years

Example practice system: Each year set a database flag for each patient who will be turning 70 to discuss their bone health

Patient aged over 50 years with a history of fracture in the last 12months

Example practice system: Set a database flag for each patient aged over 50 to ask about their fracture history in the past year, and if they have fractured, assess whether it was a minimal trauma (fragility) fracture

Number of patients identified

Have you discussed bone health or risk of fragility fracture with any of these patients?

Are there any patients you haven’t yet discussed bone health with whom you would proactively raise bone health in the next consultation?

Having completed this review do you think it is valuable to identify patients who would benefit from a discussion about discuss bone health and risk of fragility fracture and make a note in their file to discuss bone health at their next visit?

All fields highlighted are mandatory.

Success.

All fields highlighted are mandatory.

Please complete the question.

Hypothetical patient

Mrs Flava aged 74 years

Asthma and COPD diagnosed aged 58 years — long-term inhaled corticosteroid plus long-acting beta2-agonist use required, oral corticosteroids used periodically to control flare-ups of COPD.
Smoker — 38 pack-year history.
Type 2 diabetes diagnosed 10 years ago — treated with metformin/gliptin fixed-dose combination, most recent HbA1c 7.8%.

Scenario 1

Reason for encounter: “Doctor I am visiting today for a repeat prescription for my inhaler.”

In addition to Mrs Flava’s repeat prescription, which (if any) of the following comorbidities would you consider serious and urgent enough to discuss with Mrs Flava in this consultation?

Asthma

COPD

Smoking

Diabetes

Osteoporosis

Other

Scenario 2

Reason for encounter: “Doctor I have seen some information about bowel cancer and I am wondering whether I need to get checked?”

In addition to discussing bowel cancer screening, which (if any) of the following comorbidities would you consider serious and urgent enough to discuss with Mrs Flava in this consultation?

Asthma

COPD

Smoking

Diabetes

Osteoporosis

Other

All fields highlighted are mandatory.

Hypothetical patient

Mrs Bambinetti aged 61 years

Anxiety disorder diagnosed 10 years ago, recently ceased her SSRI and is using on CBT.
Atrial fibrillation diagnosed 4 years ago - treated with non-Vitamin K antagonist oral anticoagulant.
Chest X-ray taken following a recent bout of pneumonia: Radiologist reports 2 moderate wedge fractures at T7, T8. She reports no history of trauma.

Scenario 1

Reason for encounter: “Doctor, I finished my antibiotics for my pneumonia a week ago and you asked me to come back for a follow-up appointment.”

Anxiety

Atrial fibrillation

Lung disease

Osteoporosis

Other

Scenario 2

Reason for encounter: “Doctor, I have come in today for my annual flu shot.”

In addition to Mrs Bambinetti’s flu shot, which (if any) of the following comorbidities would you consider serious and urgent enough to discuss with Mrs Bambinetti in this consultation?

Anxiety

Atrial fibrillation

Lung disease

Osteoporosis

Other

All fields highlighted are mandatory.

Mrs Varga aged 81 years

Screening DEXA test results BMD T-score lumbar spine –2.2, femoral neck –1.9.

Would you initiate antiresorptive treatment?

Mrs Armstrong aged 68 years

DEXA ordered after she recently broke her wrist in a fall after tripping over her cat in the lounge room. BMD T-score lumbar spine –2.6, femoral neck –1.9.

Would you initiate antiresorptive treatment?

Mr Khan aged 73 years

25 pack-year smoking history, mild COPD. Recent DEXA results BMD T-score lumbar spine –2.9, femoral neck –2.3.

Would you initiate antiresorptive treatment?

Mrs Mori aged 68 years

DEXA ordered following X-ray showing 3 moderate vertebral crush fractures BMD T-score lumbar spine –2.1, femoral neck –1.8

Would you initiate antiresorptive treatment?

All fields highlighted are mandatory.

Strategy to overcome barrier:

The steering committee will be developing a publication on the impact of the Critical Consultations in Osteoporosis program. Your responses will be deidentified and aggregated for inclusion in this publication.

Please indicate if you DO NOT consent to your responses being part of this collated data set.

I do not consent to my responses being part of this collated data set.

All fields highlighted are mandatory.

Prioritise consultations for chronic disease, such as osteoporosis, to ensure timely diagnosis and effective ongoing management to reduce risk of fracture.

Assess the characteristics and preferences of the patient in order to individualise appropriate treatment of osteoporosis.

Determine individual need for treatment and lifestyle modifications to reduce fracture risk.

Design education strategies to enhance patients' understanding of their disease to improve self-management in chronic diseases.

Create practice systems to support patient adherence to their management plan.

4. Please rate the degree your individual learning needs were met

5. Please rate how relevant this activity is to your practice

Back-in-practice activity

Overall scientific quality

Fairness and balance of content

Suitability of format

8 . Does this activity motivate you to change systems or processes in your practice that would improve patient safety?

If yes, describe what changes you would make:

(Highly unlikely)

(Highly likely)

Thank you for completing this evaluation.

Success.

All fields highlighted are mandatory.

Why focus on osteoporosis?

The effects of a fracture due to osteoporosis can be serious, yet it remains an underdiagnosed and undertreated disease.⁴

Less than 20% of patients with a minimal trauma fracture are investigated for osteoporosis.⁴

References:

1. Watts JJ, et al. Osteoporosis costing all Australians: A new burden of disease analysis 2012 to 2022. Osteoporosis Australia 2013.
2. PBS criteria for treatment. Available from http://www.pbs.gov.au
3. Henry MJ, et al. J Clin Densitom 2000;3:261–68.
4. Osteoporosis National Action Plan Working Group. Osteoporosis National Action Plan 2016, Sydney, 2016.

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