So Why Does Does a Radiologist Treat Osteoporosis?

Radiologists in general don't typically see patients directly. They spend most of their time interpreting imaging studies. The sterotypical radiologist spends their days in a dark room looking at x-rays.

Although that is true to some extent, interventional radiologists typically take a more active role in seeing patients and directing patient care. For example, as an interventional musculoskeletal radiologist, I see patients on a daily basis with vertebral compression fractures.

Like many radiologists, when I started fixing these fractures with vertebroplasty and kyphoplasty I sent them back to thier doctor, presuming that the primary care physician to take care of medical management of osteoporosis. After several years of experience, however, I began noticing that we would see patients back again and again. Their doctor never did get them started him on appropriate therapy.

My intention is not to bash primary care physicians (PCPs)--far from it. Actually, there are many reasons for this phenomenon. First, PCPs have less time than ever to do their job. Two big factors are pressures from HMOs and insurers to see more patients in less time and the sheer number of medications that the average geriatric patient is on.

Second, osteoporosis management is complicated and requires a high degree of sophistication and diligence in order to achieve satisfactory management. Try doing that in a five minute visit with a patient on 20 medications.
Yet, a recent industry study looked at a list of things a doctor needs to address with patients during a routine visit. Osteoporosis didn't even make it into the top 10.

We kept seeing our patients coming back with more fractures and never placed on medication. So, we took ownership of managing this disease in our patients. I have personally devoted lot of time and energy, including continuing medical education compromise management for my patients.

Of course, there are many capable PCPs who prefer to continue managing osteoporosis in their patients. However, there are many more who would appreciate our approach and actually prefer to let us handle this work for them.

Who Treats Osteoporosis?

Who do you see if you have a heart attack? A cardiologist. What if you have a brain tumor? A neurosurgeon. If you have osteoporosis? There is really no one right answer.

Osteoporosis is an unusual disease, in that no single medical specialist is considered the "go to" physician for treatment. If you find an osteoporosis specialist in your area, their medical specialty may vary: family practice, rheumatologists, endocrinologists, internists, nephrologists, orthopedic surgeons and radiologists. The reason for this is that osteoporosis is a complex chronic disease it has many underlying causes factors and manifestations.

Someone with uncomplicated located osteoporosis--that is, no fragility fractures--is often managed medically. Most commonly this is done by the patient's primary care physician such as a family physician, internists her OB/GYN.

If they have a hip fracture, then they will likely see an orthopedic surgeon. Or, they may see an interventional radiologist for a vertebral compression fracture. But often these physicians may not treat the underlying medical cause.

Other times, the patient have osteoporosis secondary to medications they are on or medical conditions they suffer from. For example,rheumatologists often see patients on chronic steroids for rheumatoid arthritis or other painful joint conditions. Likewise, nephrologists often see patients with chronic renal failure which is a cause of osteoporosis. In these situations, this particular physician see a large number patients with osteoporosis and therefore treat the disease.

There other physicians who take an interest in managing osteoporosis due to the large volume patients that they see with this condition. For example, in my community many OB/GYN and women's specialists as well as myself see patients with osteoporosis.

Radiologist don't commonly treated patients with osteoporosis. In my next post I will discuss why we began this treatment.