Bisphosphonates for Osteoporosis: Podcast with James Deardorff and Sei Lee

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GeriPal - A Geriatrics and Palliative Medicine Podcast 45 min 5 speakers 8 chapters transcribed 3 days ago

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What is the overall focus of this episode on bisphosphonates for osteoporosis?

Alex Smith 0:02

The Jerry Pal podcast is brought to you by Archstone Foundation. Archstone Foundation. Improving the health and well-being of older Californians and their caregivers.

Eric Widera 0:13

For those on YouTube, you can see me and Alex battling over one mic with our masks on. We also want to acknowledge the generous donations from our listeners, including...

Alex Smith 0:24

Trisha Gachet, Christine Laramie, Jennifer Brokaw, Kim Corsine, David Scheffling, Cheryl Phillips, and Jessica Ang.

Eric Widera 0:33

And if you're interested in helping out support the Jerry Pal podcast, go to the jerrypal.org website and just click on the big blue donate button. Welcome to the Jerry Pal podcast. This is Eric Badera. This is Alex Smith. And Alex, who do we have

Alex Smith 0:51

with us today? Today, we are delighted to welcome James Deardorff, who is a geriatrician and a T32 research fellow in UCSF's Division of Geriatrics. Welcome to the Jerry Pal podcast, James. Thanks for having me. And

Eric Widera 1:07

an active Twitterati.

How did the hosts choose a song request and why was “Bad to the Bone” selected?

Eric Widera 1:08

What's your Twitter handle, James?

James Deardorff 1:11

It's at WJDeardorff.

Alex Smith 1:13

Yes. James has this terrific Twitter thread. I recommend all of you follow it. He will post articles that he has read highlighted with key points noted. Absolute treasure. We're also delighted to welcome back Sei Li, who is a frequent guest and host on the Jerry Powell podcast, a geriatrician, palliative care clinician researcher, also in the UCSF Division of Geriatrics. Welcome back to Jerry Powell, Sei.

Eric Widera 1:40

Great. Thanks for having me. So Say and James, as well as others, just published a paper in JAMA IM on the time to benefit of bisphosphonate therapy for prevention of fractures among postmenopausal women with osteoporosis. That's a long title. We'll shorten it to time to benefit from bisphosphonates for this podcast. But before we get into that topic, meaty topic, does somebody have a song request for Alex?

James Deardorff 2:09

I do. I do.

Eric Widera 2:11

James, song request.

James Deardorff 2:13

So I wanted to pick some song that was related to Bones. And when you type in Bones songs into YouTube, there's a few options. What came up was Hannah Montana, Bone Dance.

Alex Smith 2:25

Remember we're PG.

James Deardorff 2:28

Some things by Bone Thugs-N-Harmony, which I didn't think would be appropriate.

Eric Widera 2:32

Boney M? What about Boney M? You can do like Ra Ra Rasputin.

James Deardorff 2:37

There you go. But ultimately... decided to go with Bad to the Bone by George Thorogood. Nice.

Alex Smith 2:45

An awesome choice. Throwing

James Deardorff 2:46

Alex a bone there.

Alex Smith 2:48

It's like boning in the boneyard. Remember Fishbone? Ah,

James Deardorff 2:51

they were so

Alex Smith 2:52

good. Except I'm not a bass player, and

Sei Lee 2:54

clearly

Alex Smith 2:54

you need a bass player. All right, here's a little bit of George Thorogood and Destroyers, Bad to the Bone. Now on the day I was born The nurses all gathered round And they gazed in wide wonder At the joy they had found The head nurse spoke up Said leave this one alone She could tell right away, honey That I was bad to the bone

Unknown 3:31

Bye. Bye. Bye.

Eric Widera 3:56

Well

James Deardorff 3:57

done.

Eric Widera 3:58

Alex liked that too much. You should have picked the Hannah Montana song.

James Deardorff 4:01

Way too much. You need to torture him somehow. Yeah, I like when he struggles

Eric Widera 4:07

a little bit. All right, so we're going to be talking about time to benefit of bisphosphonate therapy for treatment of osteoporosis. Before we get into the subject, James, how did you get interested in this?

James Deardorff 4:23

Yeah, so I completed my geriatrics fellowship last year. And I think as we go through fellowship, you get a lot of teaching about osteoporosis since it's so common in older adults. And I was really excited just to learn how to manage these patients because in the patients in geriatrics clinic that we see, fractures just can be so devastating and result in loss of independence. And so many older adults with diagnosis of osteoporosis have never received any therapy for it. And I think what I realized, especially during COVID, is that there's just so many barriers and hesitations to starting medications as clinicians were maybe hesitant to start treatments because we're dealing with patients with multiple comorbidities, polypharmacy, frailty.

James Deardorff 5:13

I know a lot of my patients, there were concerns about ability to take the medication without supervision since they weren't having as much caregiver support during COVID. or they had difficulty coming into the clinic for an infusion.

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Chapters

8 chapters

1 What is the overall focus of this episode on bisphosphonates for osteoporosis? 0:02–1:08 2 How did the hosts choose a song request and why was “Bad to the Bone” selected? 1:08–6:07 3 What personal story does Alex share about his mother’s experience with oral and IV bisphosphonates? 6:07–10:38 4 Why is the concept of “time to benefit” important when prescribing bisphosphonates? 10:38–19:14 5 How did James and Sei design their JAMA‑IM study to measure time to benefit for fractures? 19:14–24:36 6 What did the study find about the time to benefit for non‑vertebral and hip fractures? 24:36–30:29 7 How should clinicians apply these findings to start or stop bisphosphonate therapy in older adults? 30:29–34:26 8 What is the new ePrognosis “Time to Benefit” tool and how does it help with treatment decisions? 34:26–45:12

Speakers

5 identified

James Deardorff 14 min Sei Lee 14 min Eric Widera 7 min Alex Smith 7 min Bruno Satin

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Topics in this episode

COVID 1 Alex Smith 1 UCSF 2 dementia 1 Archstone Foundation 2 osteoporosis 1 JerryPal Podcast 2 finasteride 1 bisphosphonates 1 Sei Lee 2 JAMA IM 1 Alendronate 1

Source

Recorded17 Feb 2022

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524658

Show notes

My mom is an Asian woman in her 70s with osteoporosis. She tried an oral bisphosphonate and had horrible esophagitis. She said never again, though she eventually tried an IV bisphosphonate. She had terrible flu-like symptoms. She said never again. But based on reports that symptoms are worse the first time, she tried the IV again the next year and fortunately experienced no symptoms. (Story used with permission, thanks mom!). I tell this story because these issues don't typically register as more than a nuisance for clinicians, who frequently don't understand why their older patient with osteoporosis is not taking a bisphosphonate. But our patients are walking with their feet, and adherence to bisphosphonates for osteoporosis is poor and decreases with time. When we have a medication with up front harms and downstream benefits, it's critical that we consider the time to benefit, or how long it will take an individual to benefit from a test or treatment. Think of the 10 years it takes to benefit from colon or breast cancer screening, which is designed to detect slow growing cancers. For individuals with a life expectancy less than the time to benefit, the up front harms outweigh the downstream benefits. In this context, we talked this week with James Deardorff and Sei Lee about their study of time to benefit of bisphosphonates for osteoporosis, published in JAMA IM. What they found somewhat surprised us: it's pretty short, about 1 year! Which makes me feel better about urging my mom to get treatment. Bisphosphonates are pretty darn effective, and act quickly. We also discuss discontinuing bispohsophantes, and if we can use the same logic we consider when starting them. Toward the end we talk about the launch of ePrognosis' new Time to Benefit tool. This tool provides a clinical recommendation for starting/stopping medications and cancer screening based on the prognosis of the patient in front of you. See screenshot below. You can either access it directly here. I you use the Lee Schonberg prognostic index for community dwelling older adults you will be directed to the tool, and it will automatically place the life expectancy at the calculated prognostic estimate. James and Sei requested a terrific song - Bad to the Bone - much better than the Hannah Montana Bone Dance song they threatened me with (maybe next time). Enjoy! -@alexSmithMD

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