Megan E. Milne, MD

Megan E. Milne, MD, a rheumatology fellow at Duke University in Durham, North Carolina, discusses efforts to encourage the referral of patients with prostate cancer treated with androgen deprivation therapy (ADT) to the High Risk Osteoporosis Clinic (HIROC) at her former institution, the University of Texas Southwestern. ADT decreases bone mineral density and increases patients’ risk of iatrogenic osteoporosis and minimal trauma fractures, but this risk is often under-discussed and referral rates to HIROC of patients treated with ADT were initially very low. By creating a best practice advisory (BPA) and conducting provider education meetings, doctors at HIROC were able to increase the referral rate from 4% to 59%, thus increasing the number of post-intervention patients receiving DXA and vitamin D monitoring. Dr. Milne notes that many patients with HIROC referral still did not receive anti-resorptive therapy, largely because of logistical delays, but concludes that they achieved sustained improvement in addressing bone health through both the development of a medical record BPA, and interdepartmental collaboration and education.