Transcription:
Fracture Liaison Services at GCRMC

Joey Wahler (Host): As we age, diminishing bone density can lead to breaks and falls, but there's a service to minimize that risk. So we're discussing Fracture Liaison Services. Our guest, Dayna Pridgen, she's a Nurse Practitioner for Gerald Champion Regional Medical Center.

Welcome to the Champions for Wellness Podcast, brought to you by Gerald Champion Regional Medical Center. We believe knowledge is the key that opens the door to a healthy life. Thanks for listening. I'm Joey Wahler. Hi, Dayna. Thanks for joining us.

Dayna Pridgen, CNP (Guest): Hey, thanks for having me.

Host: Great to have you here. So as we age, and we'll get into more details of course in a moment, but how common is this problem of having failing bones and suffering falls along with that?

Guest: It is very common. We actually do get referrals and assessments of anybody over the age of 50 that have risk factors and that are at risk for falls and fractures. Very, very common in women. And it is more common in men than you would think as well.

Host: So more for women than for men, but it affects both.

Guest: Yes.

Host: So simply put, what are these Fracture Liaison Services and are they just for those suffering from bone issues like osteoporosis? Or is it for anyone that age-wise or otherwise may be at risk?

Guest: So we are a clinic that specializes in bone health. Anybody over the age of 50 that has risk factors or a fracture, we do like to evaluate them. We can evaluate younger patients that have significant risk factors. We provide bone evaluation and then we also help develop a personalized plan to maintain bone health and prevent future fractures.

In saying this, we do look at a patient as a whole to determine if there are modifiable versus non-modifiable factors affecting the patient's bone health. We also go at it at a multidisciplinary approach, so I know that I personally work with the patient's primary caregiver, orthopedic specialist, nephrologist, or any other care provider, and we try to provide a cohesive environment and come up with a treatment plan for the patient.

Host: Gotcha. And I'll ask you more about that in a moment, but you mentioned risk factors, so what would some of those be?

Guest: So, ethnicity is a risk factor. The sex is a risk factor. If they smoke, if they drink alcohol, if they have other medical conditions, if they have genetic factors, family history, things like that.

Host: So that aside, you normally would recommend age-wise that people start getting checked for their bone health at around 50.

Guest: Yes. So if they have significant risk factors or if they've ever fallen or had a fracture before, we start screening at 50. Routine screening for Medicare is usually 65, but we feel like that might be a little late. So we like to start at least the screening process and meeting with the patient at age 50. And like I said, they can even be younger if they have significant risk factors.

Host: Right. So what would an initial visit consist of?

Guest: So first of all, what I like to do is to discuss the program in detail with the patient and the family, and then I review their medical history and their risk factors. And as I discussed before, I try to determine if they have any modifiable risk factors that we can work on to improve their bone health.

And this would be medications that can decrease their bone density, social habits like smoking, drinking alcohol, or lack of exercise. And then I would start with a bone density test to see where we are, get some blood work to further evaluate the bone health. When we do blood work, it'll help determine if there's any secondary medical causes of decreased bone density that can possibly be treated as opposed to just throwing medicines at them. So we do a full evaluation.

Host: And what would be an example of a condition that would affect bone density?

Guest: Chronic kidney disease does affect that. If you have elevations in your thyroid hormone, that can affect that. If you have hyperparathyroidism, that can affect that as well. So there are many secondary conditions that we can try to treat and improve, which would improve their bone health as well.

Host: Gotcha. Now, you mentioned Gerald Champion Specialists do work with a patient's primary care doctor to form a treatment plan. So tell us a little bit how that sort of partnership works.

Guest: So what I do is I will reach out to their primary care provider and discuss their care with them as well, so we can try to come up with a treatment plan together to make sure that the primary care is comfortable or that their specialists are comfortable with the medications that I do prescribe to make sure it doesn't interact with anything. And I feel like that's a good, cohesive environment and the patient is more comfortable with that as well.

Host: And if a medication or a special diet is needed for someone that'll be prescribed and monitored going forward, correct?

Guest: Yes, we do have little booklets that we have made about exercise programs. We have calcium rich foods, vitamin foods, things like that, that we can provide as a diet and exercise program as well.

Host: And when you mention exercise program, there's such a thing as a full risk program to address that specifically, maybe please give people an idea of when we say exercise to help reduce the risk of falling. What kinds of movement are we talking about?

Guest: So we focus on weightbearing exercises for upper extremities and lower extremities as long as the orthopedic surgeon has cleared them to do so. There is a specialized program, it's called the Otago Program, that we refer if the patients are a fall risk and if they want to do it, if they're okay with doing that. We send them to physical therapy for a specialized program to help prevent falls and it works on balance and gait training and exercises.

If they don't want to go, then I do provide them with a booklet they can use for home exercise program. But like I said, everything with weightbearing and we don't want to go crazy with the weights, but we usually recommend, you know, one to 10 pounds of weightbearing exercises at least 30 minutes a day.

Host: So really it sounds like talking here about a team effort, right? The primary care doctor is involved, orthopedics, people dealing with metabolic or dietary issues. So sometimes it could be sort of a multidisciplinary plan, right?

Guest: Yes.

Host: And so what's the key in you all bringing that all together and making that work for the patient?

Guest: The goal here is to have, like you said, a multidisciplinary action, and a plan that everybody feels comfortable with. So I do inform them that I am going to talk to their providers if they're okay with that, and that way they will be comfortable with the plan I set in motion. We do have some patients that do like to talk to their primary cares before I initiate medication, and I'm okay with that. I encourage that. I also encourage them to do their own research and I will contact the other providers as well just to make sure we're all on the same page.

Host: So we're talking so far here about things that are all physical, but from a psychological standpoint, a mental health standpoint, in your experience, people that either have fallen or are at high risk of falling; I would imagine that can really get to your head if you know that there might be an accident lurking around the corner, no?

Guest: Yes, that is very true. And that's why we do encourage the fall prevention physical therapy exercises because it makes them feel more comfortable in their gait, in their standing, from a chair, things like. That to make them prevent falls. It does weigh on them, especially if you tell them they do have brittle bones or osteoporosis, things like that.

But we try to do everything we can with medication management, with exercise, with diet, with supplements to try to improve their bone health so they won't have fractures and they will not be as terrified to have that.

Host: And so to pick up on that, in summary, what would you say is the main benefit or two overall for people using these services?

Guest: So I feel like the FLS program is a unique service because we try to get to the bottom of bone health and then we treat it appropriately. We not only try to help treat it, but we try to discover if there's any secondary causes to try to help fix them. We treat them as a whole. So I just, I feel like we are a unique service in doing that. And primary cares, they hit on it as well, but we do specialize in this, so I feel like we are able to give it a little bit more attention.

Host: And so if someone listening has been thinking of pursuing this type of service and treatment, but maybe they're a little leery for whatever reason, you would say what to them?

Guest: So what I do is I tell them they don't have to have a referral. They can call and schedule an appointment on their own. And then I tell them they can come in for an initial visit. We don't have to start medications right away. I talk to them. I try to make them feel comfortable. We try to figure out why they're having falls, why they are having fractures, why their bones are more brittle than they should be.

We try to get to the bottom of that and then I tell them to go home and research medications. I give them handouts and I want them to feel comfortable with the decision that they make, so I never try to pressure them. We have a big discussion with them and their family members.

Host: Well folks we trust you're now more familiar with FLS as it's known, Fracture Liaison Services. Good information to say the least. Dayna Pridgen, thanks so much again.

Guest: Thank you for having me.

Host: Thanks for being here. And for more information, please visit gcrmc.org/services/fracture-Liaison-service/. Now if you missed one of our podcasts, please visit gcrmc.org/podcast.

If you found this podcast helpful, please share it on your social media, and thanks again for listening to the Champions for Wellness podcast, local caregivers, educating our community, hoping your health is good health. I'm Joey Wahler.