April 7, 2025 • 30 mins
Osteoporosis remains a significant health concern, with new screening and treatment guidelines aiming to improve prevention and care. This episode explores updated recommendations, the latest therapeutic options, and how medications for other conditions can impact bone health. Stay informed and ready to support your patients—tune in to learn how pharmacists can make a difference.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Erin Raney, PharmD, BCPS, BC-ADM
Professor
Midwestern University College of Pharmacy, Glendale Campus
Pharmacist Members, REDEEM YOUR CPE HERE!
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Explain the updated screening and treatment guidelines for osteoporosis and their implications for patient care.
2. Identify medications that affect bone health strategies for pharmacists to mitigate their impact on osteoporosis risk.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-088-H01-P
Initial release date: 4/7/2025
Expiration date: 4/7/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, and, as always, I'm super excited
about our conversation today.
Osteoporosis is often called asilent disease, quietly
weakening bones until fracturescause serious and life-altering
complications.
In this episode, we'll unpackthe latest screening and
(00:26):
treatment guidelines, explorehow medications impact bone
health and discuss the vitalrole pharmacists play in
protecting patients from thishidden threat.
And it's so great to have ErinRainey as our guest expert for
today's episode.
Erin, thanks so much forjoining us.
Speaker 2 (00:41):
I'm really excited to be here.
Thank you.
Speaker 1 (00:43):
Yeah, we appreciate you taking time out of your
schedule.
So for our learners that maynot know, you, erin, take just a
couple minutes.
I always like to give thespeaker a few minutes to kind of
introduce themselves, talkabout your practice site and
maybe tell us about you know whyyou're passionate about today's
topic.
Speaker 2 (01:00):
Well, thank you.
I am a professor of pharmacypractice at Midwestern
University College of Pharmacy.
I'm here at our GlendaleArizona campus and I have been
working in the area of familymedicine over 20 years and
really have developed such apassion for women's health.
Over that time I have taught inthe classroom about women's
(01:22):
health topics, worked withinfamily medicine in that area and
have just recently transitionedinto working on our campus side
, outside of the practice area,and promoting our professional
development activities with ourstudents.
However, I'm still in theclassroom regarding women's
health, and that will always bean area of interest.
(01:42):
Awesome.
Osteoporosis certainly fits inthat area.
Men get osteoporosis too, so wemight end up talking about that
.
Speaker 1 (01:51):
That's true, that's true.
Yep, especially, yeah, yeah,for sure, especially if they're
on certain medications or that'sweakening or whatever.
So, yeah, well, that's great.
Thanks again for joining us.
We appreciate you taking timeto talk about.
You know, as I mentionedjoining us, we appreciate you
taking time to talk about.
You know, as I mentioned, mysegues I feel like sometimes are
(02:12):
so dramatic, you know, likethis life altering or you know
hidden thread or whatever.
But it really is likeosteoporosis is kind of that
silent thing, kind of lurking inthe background, that you know
people may not fully realizethat their bones are just slowly
breaking down.
So I think it's reallysomething important for
pharmacists to be aware of that.
This is, you know, I hate tocall it a silent disease, but
(02:32):
sometimes it is.
Sometimes people don't realizeit until they fracture something
and then realize that they'reat risk.
So anyway, without further ado,let's jump into, kind of the
topic for today, and I alwayslike to set the stage and just
make sure we're all on the samepage.
So let's just briefly touch onthe overview of osteoporosis, so
remind us exactly what it iskind of, what its implications
(02:56):
Talk about, maybe some riskfactors and things like that.
Speaker 2 (02:59):
Sure, Well, osteoporosis in itself is low
bone mass, which in itself mightnot be an issue, except it puts
us at risk for fracturing.
And when we think about ourbone remodeling process
throughout our lifetime, it'simportant that our osteoblasts
(03:19):
and osteoclasts have thisbalanced activity to clear out
bone and rebuild bone.
That happens at various ratesthroughout our skeleton
throughout our lifetime.
What happens as we age forwomen typically at the age of
menopause, and then men, this,not a more steady decline over
time, that bone remodelingprocess gets imbalanced, so the
(03:43):
clearing out of the bone is moreefficient than the building
backup and we end up with askeleton that is not as strong
and resistant to fracture if wewere to fall.
So one of two out of two womenin the US age 50 or over will
have a fracture in her lifetime.
(04:04):
One of four men will have thesame thing.
So we know it is a big issueyeah, important for us to pay
attention to.
Speaker 1 (04:14):
I feel like that statistic is a little surprising
for me.
I don't think I would haverealized one in four men, you
know, you always just kind ofthink of osteoporosis being the
frail you know disease that hitsfrail females or whatever.
But yeah, that's veryinteresting.
Okay, that's great.
Let's talk a little bit aboutif, as I mentioned, and I've
(04:36):
said it a couple of times, it'skind of that silent issue, right
, but once we know that it's aproblem, or obviously once
there's a fracture, what doesthat do to quality of life for
the patient?
Speaker 2 (04:49):
Right.
Fractures are absolutelyimportant to prevent because we
do know that sometimes less thanhalf of individuals that have a
hip fracture will end upregaining their pre-fracture
quality of life in terms ofactivities of daily living, and
sometimes it does change theirability to live on their own.
So there's morbidity related toosteoporosis and there's also
(05:13):
mortality.
So we have increased rates ofdeath after fractures.
In some cases it's due toinfection rates, pneumonia,
having to live in a skillednursing facility, but I think
that's sometimes surprising forthe public to recognize that a
fracture in the spine or the hipcan have such a huge impact on
(05:34):
the remainder of their life.
Speaker 1 (05:35):
Yeah, yeah, I know, actually, for a couple of my
grandparents that was the finalstraw that took them down was
was an actual was, a fall in afracture, and you know they
quickly dwindled and and weregone within a few months.
So, yeah, it's, it's a veryreal thing that you know, we
(05:57):
think of.
You know, as if a kid breakstheir arm, like, oh, they're
going to get a cast, and thenyou know it's fine and they're
going to be fine in a month orwhatever, but you know it's a
it's a really big deal when ourolder patients break something.
So, yeah, so what is what's outthere to prevent this?
Obviously, screenings andmedications, but like, let's
(06:20):
let's touch on the role ofscreening and prevention first
and then we can touch on therole of actually treatment and
maintenance and whatnot.
But let's briefly discuss, youknow, what are our screening
options.
What does that look like rightnow?
Speaker 2 (06:34):
Right?
Well, there's many ways toscreen for bone density itself,
and the gold standard is a DEXAscan.
And the gold standard is a DEXAscan.
Usually, the hip and spine isthe best place to scan so that
we can see right where the mostworrisome fractures are
occurring and you're testingjust those spots.
(06:54):
We know that at menopause it isa swift decline in estrogen at
that point and that reallyimpacts bone health.
So most expert groups agreethat at menopause it's important
to assess a woman's risk forfracture.
If they have an additional riskfactor like family history of
osteoporosis, they might starttheir bone density testing at
(07:18):
that time.
But at least by age 65, everywoman should be having bone
density testing done.
It is important also toremember that the assessment of
risk is not just looking at thebones in terms of bone density
or a DEXA scan.
It's also assessing risk basedupon family history and some of
(07:41):
our other attributes that mightput us at risk for a fracture.
That could be the othermedications that we're taking,
certain disease states that wemight have, or other medical
conditions, our physicalactivity level, whether we're a
smoker.
If we get adequate calcium andvitamin D.
Speaker 1 (08:06):
So there's a lot that's in play for the picture
of assessing risk.
Yeah, what about Erin likeobesity?
Is that an actual risk factor,Like because carrying around the
extra weight and again thatwould lead to inactivity
potentially, and things likethat?
What's your thoughts on that?
Speaker 2 (08:19):
I think that it's a really interesting question,
because we're used to obesityplacing a higher cardiometabolic
risk for things like diabetesand heart disease.
However, a low body weight isactually a greater risk for
osteoporosis, and the mainreason is that that bearing of
weight, that weight bearingactivity, even of our own weight
(08:40):
, is something that can keepbones stronger throughout life.
And so we really want toconsider that weight-bearing
exercise is something that isimportant.
Now, if someone has obesity, itis important for so many other
reasons to achieve goodcardiometabolic health, for
instance but it isn't a specificrisk for osteoporosis fractures
(09:03):
.
Speaker 1 (09:04):
Interesting, yeah, and you talked about menopause.
So I just want to go back tothat really quickly, so kind of
as a summary, because we had arecent podcast on menopause and
perimenopause and kind oftalking about that.
So but just to summarize, weknow that women hit menopause at
(09:27):
different times in their life,at different phases, and so
there's not a by the age of 52,you know you're going to have
gone through, you know A, b andC or whatever.
So there's you had mentioned 65for sure is when they should
start screening.
But at the time of menopause,whenever that is, they should
have that discussion todetermine whether or not they're
(09:47):
at further risk and should theybe assessed at that time?
Absolutely.
Speaker 2 (09:52):
Yeah, and premature menopause.
The average age of menopause inthe US is around 51, 52 years
old, so that can be a prettyreasonable broad statement at
that age.
But if someone has prematuremenopause younger than 45,
especially younger than 40, thenbone health is going to be an
important issue for managingtheir lifelong plan there.
(10:16):
Because of that lack ofestrogen, that's even longer
than the typical menopausal.
Speaker 1 (10:20):
Right, right, yeah, potentially even a decade longer
without the estrogen andwhatnot.
So, yeah, okay, yeah, thatmakes sense.
So we've talked a little bitabout screening and how that can
play a role in preventing.
So what about if we find outthat someone does have
osteoporosis?
Obviously, we know there aretreatments out there, but just
(10:41):
kind of review with us what arethose treatment options like?
What are the typical thingsthat patients will undergo?
Speaker 2 (10:49):
Yes.
Well, what's exciting now, asopposed to when I first started
teaching about women's healthtopics several decades ago, is
that we have bothanti-resorptive agents and
anabolic agents, and so we cannot only stop or slow the
clearing out of the bone, but wecan also start building it back
, and that's something new justwithin the last decade, and
(11:11):
especially in the last fiveyears, of having medications
that can really build bone.
So when we look at someone'srisk for a fracture, we can take
that T-score, which isassessing the risk of a fracture
based upon that bone mineraldensity, and determine how low
that bone density is anddepending on where they're at.
(11:34):
Pretty recent suggestions andguidance are that we might start
with an anti-resorptive agent,like a bisphosphonate, or we
might actually need to startwith an anabolic agent, which is
one of our newer drugs, and sothat's a big decision point
based upon how low is someone'sbone density and if they're very
(11:56):
high risk for a fracture rightnow.
Speaker 1 (11:59):
Yeah, side note here, I uh recently started reading
again, uh, the Harry Potterbooks.
And so when we talk about, youknow, bone regrowth, you know
there was the at times when theyactually they had a potion to
like regrow bones, and so I'mthinking about, if you know, I
wonder if that's what spawnedthe idea of these 20 years ago.
(12:22):
So, probably not.
It was probably already underdiscussion and studies and all
that kind of stuff, but Icouldn't help my mind going
there for a second.
So I still find thosefascinating, the fact that we do
have those agents now that canactually help with strengthening
and regrowth, as opposed tojust kind of stopping, as you
mentioned, the decline.
(12:42):
So okay, so that's great.
So we've kind of talked, then,about osteoporosis in general.
We've reminded our listenersabout kind of you know what does
that do, the impact on thepatient's life, their quality of
life, what happens, both youknow when, finding out so they
might go on treatment, and alsojust risk and prevention and
(13:05):
screening in general.
So let's jump into a little bitof you know what are some of
the opportunities for us aspharmacists.
So that's why we have the GameChangers podcast is we want to
be sure that we're giving youknow tips and tricks to our
listeners so that they can fullypractice at the top of their
license.
So let's talk about whatpharmacists can do in this space
(13:27):
.
So there are some pharmacistswho are in a space where
screening is happening right.
So if they have one of thosemachines and they're actually
doing that, so that's obviouslya place.
But let's, for those thataren't there and they don't have
that opportunity, tell us whyit's important to be sure that
we're up to date on screeningguidelines in general.
Speaker 2 (13:50):
Yeah, I think that when you are, depending on what
setting you're practicing in asa pharmacist, having those touch
points with individuals at allages allows us to help emphasize
screening guidelines and alsothose lifestyle changes that are
important and making sure thatthey're not on medications that
might put them at risk for lowbone mass.
(14:13):
So just having those touchpoints and being that trusted
healthcare provider that's seenthem over time and their body's
changing as they get older, thatthat is just an important
opportunity to be that resource.
Speaker 1 (14:28):
Yeah, absolutely Absolutely.
And you know, even if it'ssomething as simple as you know,
you are learning that yourpatient is going through
menopause.
They've asked questions aboutthat.
Whatever that could be a momentfor you to say, oh, you also
need to consider having adiscussion with your provider
about screening and osteoporosisand things.
(14:50):
So, again, just being mindfulof how those go hand in hand,
that can be a time for us tojump in as a pharmacist as well.
So let's, then you set up agreat segue.
You talked about medicationsthat can cause bone density loss
, so let's go ahead and jump inthere.
What are some of thosemedications?
Where do we see them?
(15:10):
What diseases are they treating?
What should we be able to lookout for?
Speaker 2 (15:14):
So really I think the prime candidate or the prime
problem child withmedication-induced osteoporosis
is glucocorticoids, and so we'renot talking about inhaled
products, we're talking aboutsystemic exposure, and it's
wonderful that for pulmonaryconditions like asthma, we've
(15:35):
really moved away from needinglong courses of systemic
steroids.
But for patients who haverheumatologic conditions that
might need prednisone or othertypes of corticosteroid therapy
over the long run, that isprobably the prime example of a
medication-induced risk.
And there are actually specificguidelines from the American
(15:57):
College of Rheumatology on howto address
glucocorticoid-inducedosteoporosis, which involves
much earlier screening.
Even the, the assessment ofrisk is using a different
assessment tool accounting forthe glucocorticoids and a lot
different recommendations onlifestyle and calcium and
vitamin d, and all of that veryaggressive care right from yeah,
(16:20):
yeah, that's very important.
Speaker 1 (16:23):
Um, I you know I it's been a while since I've
practiced, as I've mentionedbefore, but, um, what, like?
What kind of doses are wetalking about for those patients
who are using it?
On the rheumatoid side ofthings, what should we be
looking out for If we see anoccasional steroid here and
there, or is it a maintenancedose of 10 milligrams a day or
(16:46):
something like that?
Where should we be concerned?
Speaker 2 (16:49):
Yeah, I think when we , when we see the prednisone
bursts, let's say, maybesomeone's on five or five days
of a prednisone product that'snot what we're thinking about
here it's usually three, threemonths or longer and five 7.5
milligrams of prednisoneequivalent per day over that
(17:10):
period of time or more.
So it really is usually unique,luckily, because we have so
many disease-modifying drugsthat are separate from
glucocorticoids.
Now for rheumatologic disease.
But, it does happen and we needto watch for that.
Speaker 1 (17:27):
Okay, yeah, that's again a great entry point for a
pharmacist, because we're seeingall the medications that
they're on and so if we'renoticing that they're on a
maintenance dose of a steroid,that's a great point to jump in
and say hey, have you startedearly screening of osteoporosis,
because this is putting you athigher risk.
Yeah, let's talk about the-.
Speaker 2 (17:51):
Other medications I could mention real quick.
Yeah, that's what I was goingto say.
Any others?
Yeah, let's talk about that.
Speaker 1 (17:52):
Other medications I could mention real quick.
Yeah, that's what I was goingto say, any others yeah?
Speaker 2 (17:55):
Some things that deplete estrogen.
That makes sense because wehave that kind of menopausal
slide to keep in mind.
But there might be aromataseinhibitors used.
There's also medications likeproton pump inhibitors that
affect our stomach acid and thegastric pH and that might cause
(18:18):
us to decrease calciumabsorption from the gut over
time.
We're not quite sure how theydeplete or cause bone density
issues.
But some of the diabetesmedications thiazolidinediones.
So there's epidemiologicevidence of that but not quite
(18:40):
sure what to do with that dataquite yet.
So there's quite a fewmedications.
Even furosemide, a loopdiuretic, for instance, is
calcium wasting.
So there's lots of differentmechanisms by which a medication
can decrease bone density.
Speaker 1 (18:58):
Okay, yeah, I was going to mention because I
personally am on a PPI and Ihave been for many years and
I've tried to get off and I justcan't.
But there is that underlyingconcern that I have as I grow
older and am currently justcontinuously on those.
Am I putting myself at higherrisk for weakening my bones with
(19:20):
a PPI?
So I know that there's beensome controversial studies back
and forth.
Some say definitely, some saynot a problem, especially at a
lower dose, you know whatever.
But I'd be one that would loveto see more studies on that,
just to see if I can continueand be able to, like you know,
actually eat things and enjoythem versus.
(19:41):
Should I really be looking atthe future on that?
Speaker 2 (19:45):
so well, we know that the calcium citrate is not
dependent on the gastric pH forabsorption.
So if someone is using acalcium supplement, the calcium
citrate formulation will be morereliably absorbed if there's
that low acid environment from aPPI.
Speaker 1 (20:04):
That's great.
That's great feedback, thankyou.
Maybe I need to look at takinga supplement of the citrate then
, yeah for sure.
Okay, so let's talk a littlebit about too, while we're on
the topic of medications.
So I think it's reallyimportant that we talked about
ones to kind of be on thelookout for, but let's also talk
about, you know, the importanceof staying on the treatment for
(20:27):
osteoporosis, and we know that.
You know some of thosemedications have some bad side
effects or whatever, or at leastit appears bad, and so,
obviously, education is going tobe key.
But let's talk about how we canmake sure that our patients are
adherent and we keep thoserates high.
Speaker 2 (20:46):
Yeah, well, there's it's pretty bad statistics based
on who actually gets theprescription and fills it Right
For osteoporosis meds.
Like a quarter of people mightnot ever fill it for one and
then it might be upwards of ahalf of patients will not
complete beyond one year oftherapy, depending on the type
(21:08):
of medication they're on.
Speaker 1 (21:09):
So, that's.
Speaker 2 (21:10):
That's a broad statistic.
But first of all we have to getthe medication in the patient's
body.
So we have issues with makingsure that they're taking it
correctly, whether it is an oralmedication, and we have to
optimize absorption, or if it'sone of the injectable
medications, and they need touse those injectable devices
correctly.
(21:31):
And then we have the fear, likeyou said, of side effects and
concerns.
And so really, when we look atbisphosphonates kind of the
traditional alendronate orisedronate we know that we can
really minimize risk related togastroesophageal irritation by
(21:54):
having the patient take itcorrectly, sitting upright for
30 minutes after ingesting it,making sure that it's well
absorbed on an empty stomach,only with water, 30 minutes
before meals.
We have all thoserecommendations down pat.
We have all thoserecommendations down pat, but
communicating it to a patientand actually having them
(22:14):
understand why, I think that'sthe key.
That's key Because we're askingthem to do a lot.
You know, being mindful of 30minutes and sitting up and
having to do all of theserestrictive things.
(22:36):
I've found that many times whenI've talked with patients about
why they're not wanting to stayon the medication, that
annoyance with the scheduling.
They never really wereunderstanding why it was needed.
And when we talk about the tworeasons one is actually to
improve absorption of the drugto get into their body, but then
to also protect their esophagusI think that goes a long way.
That why goes a long way tohelping a patient.
Speaker 1 (22:54):
Right.
Speaker 2 (22:54):
Be persistent with their therapy.
Speaker 1 (22:56):
Right, yeah, because, again, you know if, if they
were to lie down afterward for afew of the doses, they're
probably not going to see animmediate concern, and so then,
if they didn't know the why,they would just assume oh well,
that was information that didn'treally affect me, because
apparently nothing is wrong,it's not happening to me.
So I think it's reallyimportant, like you said, to lay
(23:19):
out the why, because not as ascare tactic, but there is a
reason why these have theserestrictions and it's to protect
you and to also, like you said,make sure that the absorption
is actually increased and isworking.
So, yeah, um, what otherbarriers, um, have you noticed?
(23:41):
So, adherence to medications,uh, potentially just the unknown
of like, oh, I didn't realize Ishould start early screening
because I went into menopauseearlier, or whatever, but any
other barriers that you've seento either treatment or screening
?
Speaker 2 (23:57):
I think the general barrier of cost can be a
consideration.
There are some agents that arereasonably affordable, but when
we look at those patients athighest risk where we need to
think about an anabolic agent,there can be a real concern with
a financial obstacle in notonly paying for the medication,
(24:20):
but having access through theprior authorization process.
Many times there's steppedapproaches that are required to
complete before they have accessto the medication.
Some of those medications doneed to be or administered by a
health provider.
So, in office visits, havingtransportation, having the
opportunity or ability to managethe the timeline.
(24:44):
So if you remember your sixmonth injection appointment and
don't put that off, these arethe types of things that come
into play as well, dr.
Speaker 1 (24:52):
Andy Roark.
Yeah, and key too to mentionthat, although they may be going
to a clinic for that injection,if we are aware of that and as
the pharmacist, it's somethingthat we can also make sure that
we're reminding them of, becausewe've seen it too often,
patients get lost to follow-upwith care, and so you know
(25:14):
they're probably not going toimmediately remember that
they're overdue for thatinjection and then it may be,
you know, several months downthe road and whatever.
So, yeah, I think it's superimportant just to kind of be
aware of what's out there fortreatment and, even if it's not
something that we're giving oradministering, as a pharmacist,
(25:35):
understanding kind of theimplications that they need to
stay on track with the scheduleand be adherent.
Speaker 2 (25:40):
Yeah, and I think that persistence of therapy is
so important because most of themedications, except for
bisphosphonates, are not durable, so the impact of the benefit
from the medication goes awayvery quickly after it's
discontinued.
And so if a medication isstopped because a patient hasn't
been going to theirappointments or they are not
(26:03):
aware of the schedule, then theyactually could be putting them
at risk for losing the benefitof the medication.
But even denosumab, if thoseare every six-month injections,
we know that abruptdiscontinuation of that can lead
to a higher risk for vertebralfractures.
There's kind of a reboundosteoclastic activity and so if
(26:27):
we get to seven months, eightmonths, nine months from that
injection, then they starthaving a risk for fracture.
That's not far in the future,it's more immediate.
So really being aware of thatadherence and persistence, Very
important Right from thebeginning drugs that will fit
that person's expectation aswell and what they want to
(26:51):
engage in.
Speaker 1 (26:52):
Yeah, for sure, like you said.
I mean, if it's a patient thatyou know and if we're consulted,
you know, with other providerson a patient and we know that
this patient has transportationinsecurities or they have
financial insecurities, you know, maybe we're not recommending
those particular medicationsthat are where they have to go
into the clinic or where they'resuper expensive or where a PA
(27:14):
is required.
So I think it's key again tounderstand what all the options
are so that we can make surethat we're giving the best
recommendation, you know, whenasked, when collaborating with
care.
So, yeah, Well, we are runningout of time, aaron, so I want to
be sure that I wrap us up, butis there anything else specific
(27:37):
One thing I'd like for you to do, if you don't mind I know we
mentioned before we got on theactual recording can you just
call out what the screeningguidelines are called, just so
that patients will, so that ourlisteners will know what to kind
of look for, so they can besure they're up to date on the
guidelines.
Speaker 2 (27:54):
Yeah, there's actually two resources that I
think are amazing the mostrecent screening guidelines, the
US Preventive Services TaskForce.
Just last month, now that we'rein February, they published a
final report on the most recentguidelines for screening.
That's always evidence-basedand supports some of the
(28:15):
recommendations I spoke ofearlier.
The Bone Health andOsteoporosis Foundation is a
very important resource forupdated guidelines as well, for
updated guidelines as well thatdescribe screenings, also for
recommendations for men and alsosome of the other medication
recommendations that I'vedescribed, and there's been
(28:37):
about five different expertgroups in the last five years
that have updated theirosteoporosis guidelines.
Whether it's the AmericanAssociation of Clinical
Endocrinologists, the EndocrineSociety, the Endocrine Society,
the Menopause Society, theInternational Osteoporosis
Foundation All of them havepublished within the last five
years updates, and it's reallybecause of those anabolic agents
(29:00):
now that are playing a biggerrole in care.
Speaker 1 (29:02):
In the market, yeah, and so they're really kind of
changing things.
Okay, yeah, that's great.
I just wanted to be sure thatlisteners knew where to go,
because we told them it wasimportant to stay up to date on
the guidelines and the resources.
So I wanted to be sure we weresharing that.
So, okay, before we wrap up,what I always like to do is just
kind of kind of briefly touchon the game changer here.
Like, let's talk about asummary for today's episode for
(29:26):
our listeners.
So I'll kick that to you.
Speaker 2 (29:34):
Well, I think that pharmacists have an amazing
opportunity for advocacy fortheir patients, so advocating
not only for awareness andscreening and risk assessment,
but also for persisting withmedication therapy if that is
necessary and helping a patientunderstand their schedule, how
to administer the drug, get itinto their body and let's keep
the regimen going for as long asnecessary.
So we really have such animportant advocacy role.
Speaker 1 (29:56):
Yeah, that's great.
That's great.
Well, erin, thanks again.
This was great.
I really appreciate you takingtime of your busy day and
sharing your expertise with us.
I think again I'll say it oncemore I feel like it's kind of
that silent disease that wedon't talk about enough, but it
also can be super impactful in apatient's quality of life.
So thank you again for sharingthat with us.
Speaker 2 (30:18):
All right, thank you.
Speaker 1 (30:19):
Yeah, if you're a CE plan subscriber, be sure to
claim your CE credit for thisepisode of Game Changers by
logging in at CEimpactcom and,as always, have a great week and
keep learning.
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, and, as always, I'm super excited
about our conversation today.
Osteoporosis is often called asilent disease, quietly
weakening bones until fracturescause serious and life-altering
complications.
In this episode, we'll unpackthe latest screening and
(00:26):
treatment guidelines, explorehow medications impact bone
health and discuss the vitalrole pharmacists play in
protecting patients from thishidden threat.
And it's so great to have ErinRainey as our guest expert for
today's episode.
Erin, thanks so much forjoining us.
Speaker 2 (00:41):
I'm really excited to be here.
Thank you.
Speaker 1 (00:43):
Yeah, we appreciate you taking time out of your
schedule.
So for our learners that maynot know, you, erin, take just a
couple minutes.
I always like to give thespeaker a few minutes to kind of
introduce themselves, talkabout your practice site and
maybe tell us about you know whyyou're passionate about today's
topic.
Speaker 2 (01:00):
Well, thank you.
I am a professor of pharmacypractice at Midwestern
University College of Pharmacy.
I'm here at our GlendaleArizona campus and I have been
working in the area of familymedicine over 20 years and
really have developed such apassion for women's health.
Over that time I have taught inthe classroom about women's
(01:22):
health topics, worked withinfamily medicine in that area and
have just recently transitionedinto working on our campus side
, outside of the practice area,and promoting our professional
development activities with ourstudents.
However, I'm still in theclassroom regarding women's
health, and that will always bean area of interest.
(01:42):
Awesome.
Osteoporosis certainly fits inthat area.
Men get osteoporosis too, so wemight end up talking about that
.
Speaker 1 (01:51):
That's true, that's true.
Yep, especially, yeah, yeah,for sure, especially if they're
on certain medications or that'sweakening or whatever.
So, yeah, well, that's great.
Thanks again for joining us.
We appreciate you taking timeto talk about.
You know, as I mentionedjoining us, we appreciate you
taking time to talk about.
You know, as I mentioned, mysegues I feel like sometimes are
(02:12):
so dramatic, you know, likethis life altering or you know
hidden thread or whatever.
But it really is likeosteoporosis is kind of that
silent thing, kind of lurking inthe background, that you know
people may not fully realizethat their bones are just slowly
breaking down.
So I think it's reallysomething important for
pharmacists to be aware of that.
This is, you know, I hate tocall it a silent disease, but
(02:32):
sometimes it is.
Sometimes people don't realizeit until they fracture something
and then realize that they'reat risk.
So anyway, without further ado,let's jump into, kind of the
topic for today, and I alwayslike to set the stage and just
make sure we're all on the samepage.
So let's just briefly touch onthe overview of osteoporosis, so
remind us exactly what it iskind of, what its implications
(02:56):
Talk about, maybe some riskfactors and things like that.
Speaker 2 (02:59):
Sure, Well, osteoporosis in itself is low
bone mass, which in itself mightnot be an issue, except it puts
us at risk for fracturing.
And when we think about ourbone remodeling process
throughout our lifetime, it'simportant that our osteoblasts
(03:19):
and osteoclasts have thisbalanced activity to clear out
bone and rebuild bone.
That happens at various ratesthroughout our skeleton
throughout our lifetime.
What happens as we age forwomen typically at the age of
menopause, and then men, this,not a more steady decline over
time, that bone remodelingprocess gets imbalanced, so the
(03:43):
clearing out of the bone is moreefficient than the building
backup and we end up with askeleton that is not as strong
and resistant to fracture if wewere to fall.
So one of two out of two womenin the US age 50 or over will
have a fracture in her lifetime.
(04:04):
One of four men will have thesame thing.
So we know it is a big issueyeah, important for us to pay
attention to.
Speaker 1 (04:14):
I feel like that statistic is a little surprising
for me.
I don't think I would haverealized one in four men, you
know, you always just kind ofthink of osteoporosis being the
frail you know disease that hitsfrail females or whatever.
But yeah, that's veryinteresting.
Okay, that's great.
Let's talk a little bit aboutif, as I mentioned, and I've
(04:36):
said it a couple of times, it'skind of that silent issue, right
, but once we know that it's aproblem, or obviously once
there's a fracture, what doesthat do to quality of life for
the patient?
Speaker 2 (04:49):
Right.
Fractures are absolutelyimportant to prevent because we
do know that sometimes less thanhalf of individuals that have a
hip fracture will end upregaining their pre-fracture
quality of life in terms ofactivities of daily living, and
sometimes it does change theirability to live on their own.
So there's morbidity related toosteoporosis and there's also
(05:13):
mortality.
So we have increased rates ofdeath after fractures.
In some cases it's due toinfection rates, pneumonia,
having to live in a skillednursing facility, but I think
that's sometimes surprising forthe public to recognize that a
fracture in the spine or the hipcan have such a huge impact on
(05:34):
the remainder of their life.
Speaker 1 (05:35):
Yeah, yeah, I know, actually, for a couple of my
grandparents that was the finalstraw that took them down was
was an actual was, a fall in afracture, and you know they
quickly dwindled and and weregone within a few months.
So, yeah, it's, it's a veryreal thing that you know, we
(05:57):
think of.
You know, as if a kid breakstheir arm, like, oh, they're
going to get a cast, and thenyou know it's fine and they're
going to be fine in a month orwhatever, but you know it's a
it's a really big deal when ourolder patients break something.
So, yeah, so what is what's outthere to prevent this?
Obviously, screenings andmedications, but like, let's
(06:20):
let's touch on the role ofscreening and prevention first
and then we can touch on therole of actually treatment and
maintenance and whatnot.
But let's briefly discuss, youknow, what are our screening
options.
What does that look like rightnow?
Speaker 2 (06:34):
Right?
Well, there's many ways toscreen for bone density itself,
and the gold standard is a DEXAscan.
And the gold standard is a DEXAscan.
Usually, the hip and spine isthe best place to scan so that
we can see right where the mostworrisome fractures are
occurring and you're testingjust those spots.
(06:54):
We know that at menopause it isa swift decline in estrogen at
that point and that reallyimpacts bone health.
So most expert groups agreethat at menopause it's important
to assess a woman's risk forfracture.
If they have an additional riskfactor like family history of
osteoporosis, they might starttheir bone density testing at
(07:18):
that time.
But at least by age 65, everywoman should be having bone
density testing done.
It is important also toremember that the assessment of
risk is not just looking at thebones in terms of bone density
or a DEXA scan.
It's also assessing risk basedupon family history and some of
(07:41):
our other attributes that mightput us at risk for a fracture.
That could be the othermedications that we're taking,
certain disease states that wemight have, or other medical
conditions, our physicalactivity level, whether we're a
smoker.
If we get adequate calcium andvitamin D.
Speaker 1 (08:06):
So there's a lot that's in play for the picture
of assessing risk.
Yeah, what about Erin likeobesity?
Is that an actual risk factor,Like because carrying around the
extra weight and again thatwould lead to inactivity
potentially, and things likethat?
What's your thoughts on that?
Speaker 2 (08:19):
I think that it's a really interesting question,
because we're used to obesityplacing a higher cardiometabolic
risk for things like diabetesand heart disease.
However, a low body weight isactually a greater risk for
osteoporosis, and the mainreason is that that bearing of
weight, that weight bearingactivity, even of our own weight
(08:40):
, is something that can keepbones stronger throughout life.
And so we really want toconsider that weight-bearing
exercise is something that isimportant.
Now, if someone has obesity, itis important for so many other
reasons to achieve goodcardiometabolic health, for
instance but it isn't a specificrisk for osteoporosis fractures
(09:03):
.
Speaker 1 (09:04):
Interesting, yeah, and you talked about menopause.
So I just want to go back tothat really quickly, so kind of
as a summary, because we had arecent podcast on menopause and
perimenopause and kind oftalking about that.
So but just to summarize, weknow that women hit menopause at
(09:27):
different times in their life,at different phases, and so
there's not a by the age of 52,you know you're going to have
gone through, you know A, b andC or whatever.
So there's you had mentioned 65for sure is when they should
start screening.
But at the time of menopause,whenever that is, they should
have that discussion todetermine whether or not they're
(09:47):
at further risk and should theybe assessed at that time?
Absolutely.
Speaker 2 (09:52):
Yeah, and premature menopause.
The average age of menopause inthe US is around 51, 52 years
old, so that can be a prettyreasonable broad statement at
that age.
But if someone has prematuremenopause younger than 45,
especially younger than 40, thenbone health is going to be an
important issue for managingtheir lifelong plan there.
(10:16):
Because of that lack ofestrogen, that's even longer
than the typical menopausal.
Speaker 1 (10:20):
Right, right, yeah, potentially even a decade longer
without the estrogen andwhatnot.
So, yeah, okay, yeah, thatmakes sense.
So we've talked a little bitabout screening and how that can
play a role in preventing.
So what about if we find outthat someone does have
osteoporosis?
Obviously, we know there aretreatments out there, but just
(10:41):
kind of review with us what arethose treatment options like?
What are the typical thingsthat patients will undergo?
Speaker 2 (10:49):
Yes.
Well, what's exciting now, asopposed to when I first started
teaching about women's healthtopics several decades ago, is
that we have bothanti-resorptive agents and
anabolic agents, and so we cannot only stop or slow the
clearing out of the bone, but wecan also start building it back
, and that's something new justwithin the last decade, and
(11:11):
especially in the last fiveyears, of having medications
that can really build bone.
So when we look at someone'srisk for a fracture, we can take
that T-score, which isassessing the risk of a fracture
based upon that bone mineraldensity, and determine how low
that bone density is anddepending on where they're at.
(11:34):
Pretty recent suggestions andguidance are that we might start
with an anti-resorptive agent,like a bisphosphonate, or we
might actually need to startwith an anabolic agent, which is
one of our newer drugs, and sothat's a big decision point
based upon how low is someone'sbone density and if they're very
(11:56):
high risk for a fracture rightnow.
Speaker 1 (11:59):
Yeah, side note here, I uh recently started reading
again, uh, the Harry Potterbooks.
And so when we talk about, youknow, bone regrowth, you know
there was the at times when theyactually they had a potion to
like regrow bones, and so I'mthinking about, if you know, I
wonder if that's what spawnedthe idea of these 20 years ago.
(12:22):
So, probably not.
It was probably already underdiscussion and studies and all
that kind of stuff, but Icouldn't help my mind going
there for a second.
So I still find thosefascinating, the fact that we do
have those agents now that canactually help with strengthening
and regrowth, as opposed tojust kind of stopping, as you
mentioned, the decline.
(12:42):
So okay, so that's great.
So we've kind of talked, then,about osteoporosis in general.
We've reminded our listenersabout kind of you know what does
that do, the impact on thepatient's life, their quality of
life, what happens, both youknow when, finding out so they
might go on treatment, and alsojust risk and prevention and
(13:05):
screening in general.
So let's jump into a little bitof you know what are some of
the opportunities for us aspharmacists.
So that's why we have the GameChangers podcast is we want to
be sure that we're giving youknow tips and tricks to our
listeners so that they can fullypractice at the top of their
license.
So let's talk about whatpharmacists can do in this space
(13:27):
.
So there are some pharmacistswho are in a space where
screening is happening right.
So if they have one of thosemachines and they're actually
doing that, so that's obviouslya place.
But let's, for those thataren't there and they don't have
that opportunity, tell us whyit's important to be sure that
we're up to date on screeningguidelines in general.
Speaker 2 (13:50):
Yeah, I think that when you are, depending on what
setting you're practicing in asa pharmacist, having those touch
points with individuals at allages allows us to help emphasize
screening guidelines and alsothose lifestyle changes that are
important and making sure thatthey're not on medications that
might put them at risk for lowbone mass.
(14:13):
So just having those touchpoints and being that trusted
healthcare provider that's seenthem over time and their body's
changing as they get older, thatthat is just an important
opportunity to be that resource.
Speaker 1 (14:28):
Yeah, absolutely Absolutely.
And you know, even if it'ssomething as simple as you know,
you are learning that yourpatient is going through
menopause.
They've asked questions aboutthat.
Whatever that could be a momentfor you to say, oh, you also
need to consider having adiscussion with your provider
about screening and osteoporosisand things.
(14:50):
So, again, just being mindfulof how those go hand in hand,
that can be a time for us tojump in as a pharmacist as well.
So let's, then you set up agreat segue.
You talked about medicationsthat can cause bone density loss
, so let's go ahead and jump inthere.
What are some of thosemedications?
Where do we see them?
(15:10):
What diseases are they treating?
What should we be able to lookout for?
Speaker 2 (15:14):
So really I think the prime candidate or the prime
problem child withmedication-induced osteoporosis
is glucocorticoids, and so we'renot talking about inhaled
products, we're talking aboutsystemic exposure, and it's
wonderful that for pulmonaryconditions like asthma, we've
(15:35):
really moved away from needinglong courses of systemic
steroids.
But for patients who haverheumatologic conditions that
might need prednisone or othertypes of corticosteroid therapy
over the long run, that isprobably the prime example of a
medication-induced risk.
And there are actually specificguidelines from the American
(15:57):
College of Rheumatology on howto address
glucocorticoid-inducedosteoporosis, which involves
much earlier screening.
Even the, the assessment ofrisk is using a different
assessment tool accounting forthe glucocorticoids and a lot
different recommendations onlifestyle and calcium and
vitamin d, and all of that veryaggressive care right from yeah,
(16:20):
yeah, that's very important.
Speaker 1 (16:23):
Um, I you know I it's been a while since I've
practiced, as I've mentionedbefore, but, um, what, like?
What kind of doses are wetalking about for those patients
who are using it?
On the rheumatoid side ofthings, what should we be
looking out for If we see anoccasional steroid here and
there, or is it a maintenancedose of 10 milligrams a day or
(16:46):
something like that?
Where should we be concerned?
Speaker 2 (16:49):
Yeah, I think when we , when we see the prednisone
bursts, let's say, maybesomeone's on five or five days
of a prednisone product that'snot what we're thinking about
here it's usually three, threemonths or longer and five 7.5
milligrams of prednisoneequivalent per day over that
(17:10):
period of time or more.
So it really is usually unique,luckily, because we have so
many disease-modifying drugsthat are separate from
glucocorticoids.
Now for rheumatologic disease.
But, it does happen and we needto watch for that.
Speaker 1 (17:27):
Okay, yeah, that's again a great entry point for a
pharmacist, because we're seeingall the medications that
they're on and so if we'renoticing that they're on a
maintenance dose of a steroid,that's a great point to jump in
and say hey, have you startedearly screening of osteoporosis,
because this is putting you athigher risk.
Yeah, let's talk about the-.
Speaker 2 (17:51):
Other medications I could mention real quick.
Yeah, that's what I was goingto say.
Any others?
Yeah, let's talk about that.
Speaker 1 (17:52):
Other medications I could mention real quick.
Yeah, that's what I was goingto say, any others yeah?
Speaker 2 (17:55):
Some things that deplete estrogen.
That makes sense because wehave that kind of menopausal
slide to keep in mind.
But there might be aromataseinhibitors used.
There's also medications likeproton pump inhibitors that
affect our stomach acid and thegastric pH and that might cause
(18:18):
us to decrease calciumabsorption from the gut over
time.
We're not quite sure how theydeplete or cause bone density
issues.
But some of the diabetesmedications thiazolidinediones.
So there's epidemiologicevidence of that but not quite
(18:40):
sure what to do with that dataquite yet.
So there's quite a fewmedications.
Even furosemide, a loopdiuretic, for instance, is
calcium wasting.
So there's lots of differentmechanisms by which a medication
can decrease bone density.
Speaker 1 (18:58):
Okay, yeah, I was going to mention because I
personally am on a PPI and Ihave been for many years and
I've tried to get off and I justcan't.
But there is that underlyingconcern that I have as I grow
older and am currently justcontinuously on those.
Am I putting myself at higherrisk for weakening my bones with
(19:20):
a PPI?
So I know that there's beensome controversial studies back
and forth.
Some say definitely, some saynot a problem, especially at a
lower dose, you know whatever.
But I'd be one that would loveto see more studies on that,
just to see if I can continueand be able to, like you know,
actually eat things and enjoythem versus.
(19:41):
Should I really be looking atthe future on that?
Speaker 2 (19:45):
so well, we know that the calcium citrate is not
dependent on the gastric pH forabsorption.
So if someone is using acalcium supplement, the calcium
citrate formulation will be morereliably absorbed if there's
that low acid environment from aPPI.
Speaker 1 (20:04):
That's great.
That's great feedback, thankyou.
Maybe I need to look at takinga supplement of the citrate then
, yeah for sure.
Okay, so let's talk a littlebit about too, while we're on
the topic of medications.
So I think it's reallyimportant that we talked about
ones to kind of be on thelookout for, but let's also talk
about, you know, the importanceof staying on the treatment for
(20:27):
osteoporosis, and we know that.
You know some of thosemedications have some bad side
effects or whatever, or at leastit appears bad, and so,
obviously, education is going tobe key.
But let's talk about how we canmake sure that our patients are
adherent and we keep thoserates high.
Speaker 2 (20:46):
Yeah, well, there's it's pretty bad statistics based
on who actually gets theprescription and fills it Right
For osteoporosis meds.
Like a quarter of people mightnot ever fill it for one and
then it might be upwards of ahalf of patients will not
complete beyond one year oftherapy, depending on the type
(21:08):
of medication they're on.
Speaker 1 (21:09):
So, that's.
Speaker 2 (21:10):
That's a broad statistic.
But first of all we have to getthe medication in the patient's
body.
So we have issues with makingsure that they're taking it
correctly, whether it is an oralmedication, and we have to
optimize absorption, or if it'sone of the injectable
medications, and they need touse those injectable devices
correctly.
(21:31):
And then we have the fear, likeyou said, of side effects and
concerns.
And so really, when we look atbisphosphonates kind of the
traditional alendronate orisedronate we know that we can
really minimize risk related togastroesophageal irritation by
(21:54):
having the patient take itcorrectly, sitting upright for
30 minutes after ingesting it,making sure that it's well
absorbed on an empty stomach,only with water, 30 minutes
before meals.
We have all thoserecommendations down pat.
We have all thoserecommendations down pat, but
communicating it to a patientand actually having them
(22:14):
understand why, I think that'sthe key.
That's key Because we're askingthem to do a lot.
You know, being mindful of 30minutes and sitting up and
having to do all of theserestrictive things.
(22:36):
I've found that many times whenI've talked with patients about
why they're not wanting to stayon the medication, that
annoyance with the scheduling.
They never really wereunderstanding why it was needed.
And when we talk about the tworeasons one is actually to
improve absorption of the drugto get into their body, but then
to also protect their esophagusI think that goes a long way.
That why goes a long way tohelping a patient.
Speaker 1 (22:54):
Right.
Speaker 2 (22:54):
Be persistent with their therapy.
Speaker 1 (22:56):
Right, yeah, because, again, you know if, if they
were to lie down afterward for afew of the doses, they're
probably not going to see animmediate concern, and so then,
if they didn't know the why,they would just assume oh well,
that was information that didn'treally affect me, because
apparently nothing is wrong,it's not happening to me.
So I think it's reallyimportant, like you said, to lay
(23:19):
out the why, because not as ascare tactic, but there is a
reason why these have theserestrictions and it's to protect
you and to also, like you said,make sure that the absorption
is actually increased and isworking.
So, yeah, um, what otherbarriers, um, have you noticed?
(23:41):
So, adherence to medications,uh, potentially just the unknown
of like, oh, I didn't realize Ishould start early screening
because I went into menopauseearlier, or whatever, but any
other barriers that you've seento either treatment or screening
?
Speaker 2 (23:57):
I think the general barrier of cost can be a
consideration.
There are some agents that arereasonably affordable, but when
we look at those patients athighest risk where we need to
think about an anabolic agent,there can be a real concern with
a financial obstacle in notonly paying for the medication,
(24:20):
but having access through theprior authorization process.
Many times there's steppedapproaches that are required to
complete before they have accessto the medication.
Some of those medications doneed to be or administered by a
health provider.
So, in office visits, havingtransportation, having the
opportunity or ability to managethe the timeline.
(24:44):
So if you remember your sixmonth injection appointment and
don't put that off, these arethe types of things that come
into play as well, dr.
Speaker 1 (24:52):
Andy Roark.
Yeah, and key too to mentionthat, although they may be going
to a clinic for that injection,if we are aware of that and as
the pharmacist, it's somethingthat we can also make sure that
we're reminding them of, becausewe've seen it too often,
patients get lost to follow-upwith care, and so you know
(25:14):
they're probably not going toimmediately remember that
they're overdue for thatinjection and then it may be,
you know, several months downthe road and whatever.
So, yeah, I think it's superimportant just to kind of be
aware of what's out there fortreatment and, even if it's not
something that we're giving oradministering, as a pharmacist,
(25:35):
understanding kind of theimplications that they need to
stay on track with the scheduleand be adherent.
Speaker 2 (25:40):
Yeah, and I think that persistence of therapy is
so important because most of themedications, except for
bisphosphonates, are not durable, so the impact of the benefit
from the medication goes awayvery quickly after it's
discontinued.
And so if a medication isstopped because a patient hasn't
been going to theirappointments or they are not
(26:03):
aware of the schedule, then theyactually could be putting them
at risk for losing the benefitof the medication.
But even denosumab, if thoseare every six-month injections,
we know that abruptdiscontinuation of that can lead
to a higher risk for vertebralfractures.
There's kind of a reboundosteoclastic activity and so if
(26:27):
we get to seven months, eightmonths, nine months from that
injection, then they starthaving a risk for fracture.
That's not far in the future,it's more immediate.
So really being aware of thatadherence and persistence, Very
important Right from thebeginning drugs that will fit
that person's expectation aswell and what they want to
(26:51):
engage in.
Speaker 1 (26:52):
Yeah, for sure, like you said.
I mean, if it's a patient thatyou know and if we're consulted,
you know, with other providerson a patient and we know that
this patient has transportationinsecurities or they have
financial insecurities, you know, maybe we're not recommending
those particular medicationsthat are where they have to go
into the clinic or where they'resuper expensive or where a PA
(27:14):
is required.
So I think it's key again tounderstand what all the options
are so that we can make surethat we're giving the best
recommendation, you know, whenasked, when collaborating with
care.
So, yeah, Well, we are runningout of time, aaron, so I want to
be sure that I wrap us up, butis there anything else specific
(27:37):
One thing I'd like for you to do, if you don't mind I know we
mentioned before we got on theactual recording can you just
call out what the screeningguidelines are called, just so
that patients will, so that ourlisteners will know what to kind
of look for, so they can besure they're up to date on the
guidelines.
Speaker 2 (27:54):
Yeah, there's actually two resources that I
think are amazing the mostrecent screening guidelines, the
US Preventive Services TaskForce.
Just last month, now that we'rein February, they published a
final report on the most recentguidelines for screening.
That's always evidence-basedand supports some of the
(28:15):
recommendations I spoke ofearlier.
The Bone Health andOsteoporosis Foundation is a
very important resource forupdated guidelines as well, for
updated guidelines as well thatdescribe screenings, also for
recommendations for men and alsosome of the other medication
recommendations that I'vedescribed, and there's been
(28:37):
about five different expertgroups in the last five years
that have updated theirosteoporosis guidelines.
Whether it's the AmericanAssociation of Clinical
Endocrinologists, the EndocrineSociety, the Endocrine Society,
the Menopause Society, theInternational Osteoporosis
Foundation All of them havepublished within the last five
years updates, and it's reallybecause of those anabolic agents
(29:00):
now that are playing a biggerrole in care.
Speaker 1 (29:02):
In the market, yeah, and so they're really kind of
changing things.
Okay, yeah, that's great.
I just wanted to be sure thatlisteners knew where to go,
because we told them it wasimportant to stay up to date on
the guidelines and the resources.
So I wanted to be sure we weresharing that.
So, okay, before we wrap up,what I always like to do is just
kind of kind of briefly touchon the game changer here.
Like, let's talk about asummary for today's episode for
(29:26):
our listeners.
So I'll kick that to you.
Speaker 2 (29:34):
Well, I think that pharmacists have an amazing
opportunity for advocacy fortheir patients, so advocating
not only for awareness andscreening and risk assessment,
but also for persisting withmedication therapy if that is
necessary and helping a patientunderstand their schedule, how
to administer the drug, get itinto their body and let's keep
the regimen going for as long asnecessary.
So we really have such animportant advocacy role.
Speaker 1 (29:56):
Yeah, that's great.
That's great.
Well, erin, thanks again.
This was great.
I really appreciate you takingtime of your busy day and
sharing your expertise with us.
I think again I'll say it oncemore I feel like it's kind of
that silent disease that wedon't talk about enough, but it
also can be super impactful in apatient's quality of life.
So thank you again for sharingthat with us.
Speaker 2 (30:18):
All right, thank you.
Speaker 1 (30:19):
Yeah, if you're a CE plan subscriber, be sure to
claim your CE credit for thisepisode of Game Changers by
logging in at CEimpactcom and,as always, have a great week and
keep learning.
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