Fran Lowry

April 07, 2014

The pharmacist can help prevent osteoporosis from occurring and, in those who already have the condition, help minimize risk for fracture, according to a presentation at the American Pharmacists Association (APhA) 2014 Annual Meeting and Exposition in Orlando, Florida.

"Pharmacists can make sure people with osteoporosis practice a bone-healthy lifestyle," Mary Beth O'Connell, PharmD, from the Eugene Applebaum College of Pharmacy and Health Sciences at Wayne State University in Detroit, told Medscape Medical News.

Dr. Mary Beth O'Connell

"They can help ensure that patients have an adequate and safe intake of calcium and vitamins, take osteoporosis medications correctly and for the appropriate time frame, and identify and resolve medication issues related to decreasing bone mass that may cause falls," Dr. O'Connell said at the meeting

Osteoporosis is a public epidemic in the United States, and the APhA has had an osteoporosis educational program at its annual meetings for the past 5 years, she said.

"Pharmacists see people before they actually get the condition, so as more pharmacists move into the area of wellness, they can be a great help," Dr. O'Connell said.

Use FRAX Before They Fracture

Regardless of whether they work in a hospital or a community pharmacy, they can use the World Health Organization Fracture Risk Assessment Tool (FRAX) to identify people with or at risk for osteoporosis, she explained.

The FRAX, available online, calculates a person's risk for an osteoporotic fracture within the next 10 years.

The tool can be used "in any pharmacy because all of the questions are asked of patients, and pharmacists do not need the electronic medical record. It can be used with or without a computer, so even though a patient may not have had an assessment of their bone density, the FRAX can predict their 10-year probability of having any osteoporotic fracture or hip fracture," Dr. O'Connell explained.

The FRAX should be used to screen postmenopausal women and men 40 to 90 years of age of any ethnicity (white, black, Asian, and Hispanic) not currently on prescription osteoporosis medications.

The tool assesses a patient's age, sex, weight, height, history of fracture, family history of hip fracture, smoking status, history of glucocorticoid use, rheumatoid arthritis status, and alcohol consumption.

"It's mainly used to determine the need for pharmacotherapy and, more recently, to determine the need for dual-energy x-ray absorptiometry [DXA]," Dr. O'Connell said.

Women 65 years and older should undergo DXA. In addition, younger postmenopausal women should undergo DXA on the basis of risk profile, which includes low body weight, previous fracture, the use of high-risk medications (such as steroids and tamoxifen), and a disease or condition that predisposes a person to bone loss.

Women 50 to 64 years of age with a FRAX overall fracture risk of at least 9.3% should also undergo DXA, according to the latest US Preventive Services Task Force recommendations, she reported.

Men 70 years or older should undergo DXA, as should men younger than 70 years who fit the risk profile outlined for younger postmenopausal women.

DXA is also useful for monitoring the success of therapy for osteoporosis, Dr. O'Connell noted.

Drug Holidays

Pharmacists also need to be aware of new US Food and Drug Administration recommendations on the need for drug holidays and limiting the duration of therapy for osteoporosis medications, she said.

"For example, although denosumab is not a new drug, more and more people are beginning to use this medication, so pharmacists need to understand this medication and help insure adherence with a drug that is given once every 6 months," Dr. O'Connell explained.

Creating an automated medication reminder system is very useful for medications like the bisphosphonates and denosumab that have extended dosing intervals, she added.

Pharmacists can also help with osteoporosis and fracture prevention in patient-centered medical homes. "They could add osteoporosis to the chronic illnesses they are responsible for and monitor pharmacy profiles to identify women who may be discontinuing their osteoporosis medications, either because of side-effect issues or for drug holidays," Dr. O'Connell said.

In hospitals, pharmacists can become part of the fracture prevention team, she added. "They can help make sure patients leaving the hospital after a traumatic fracture receive either a DXA scan or osteoporosis medication and that patients know which lifestyle changes improve bone mass. They can also review medication regimens to see if they create a possibility for bone loss or a high likelihood of falls, which can lead to fractures," Dr. O'Connell said.

The Pharmacist Is Essential in Wellness

Dr. Kelly Orr

Pharmacists can play a role in helping patients ward off or manage osteoporosis, said Kelly Orr, PharmD, from the University of Rhode Island in Kingston, who was not involved in the presentation.

"As pharmacies are moving toward a health and wellness approach, pharmacists are essential in preventative health education," she noted.

"The FRAX is a quick and easy way to assess patient's 10-year risk for fracture in the community setting, while also providing counseling on bone healthy lifestyle," Dr. Orr told Medscape Medical News.

Dr. O'Connell and Dr. Orr have disclosed no relevant financial relationships.

American Pharmacists Association (APhA) 2014 Annual Meeting and Exposition. Presented March 30, 2014.


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