Abstract
ABSTRACTLarge‐scale studies have not addressed the knowledge level of US resident physicians regarding osteoporosis management. We gauged the knowledge level of family medicine, internal medicine, and obstetrics and gynecology resident physicians regarding osteoporosis management. In 2019, we sent an anonymous survey via e‐mail to all program directors of Accreditation Council for Graduate Medical Education–accredited residency programs in family medicine, internal medicine, and obstetrics and gynecology for distribution to resident physicians. Knowledge items assessed osteoporosis screening, diagnosis, and treatment. We received responses from 182 family medicine, 275 internal medicine, and 122 obstetrics and gynecology programs. Of 582 resident physician respondents, 31% were family medicine residents, 47% were internal medicine residents, and 21% were obstetrics and gynecology residents. Although 77% of respondents correctly selected the T‐score threshold for the diagnosis of osteoporosis among persons aged 50 years and older (−2.5), only 20% of respondents correctly identified minimal‐trauma hip fracture as being diagnostic of osteoporosis. One‐third of respondents correctly identified which medications were demonstrated in clinical trials to decrease hip fracture risk. Fifteen percent of respondents correctly identified that denosumab and alendronate are associated with osteonecrosis of the jaw; and 40% of respondents correctly identified that decline in bone density is more rapid after discontinuation of denosumab than after discontinuation of bisphosphonates. Less than half of resident physicians knew that bisphosphonate‐associated atypical femoral fractures are duration‐dependent. One‐quarter of respondents felt not at all prepared to manage osteoporosis. In this nationwide survey of resident physicians, knowledge regarding osteoporosis diagnosis and treatment was poor, with a striking lack of knowledge regarding the two most serious adverse effects of osteoporosis pharmacotherapy (osteonecrosis of the jaw and atypical femoral fractures). The undertreatment of osteoporosis is unlikely to improve without increased education of resident physicians. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Highlights
One in two older women and one in three older men will experience osteoporosis-related fractures in their remaining lifetimes.[1]
Between December 6, 2019, and March 12, 2020, we sent e-mails to program directors of all of the Accreditation Council for Graduate Medical Education (ACGME)–accredited residency programs (282 obstetrics and gynecology programs, 675 family medicine programs, and 544 internal medicine programs) that were listed on the ACGME public-access webpage on August 7, 2019
Thirty-one percent reported being in a family medicine program, 47% were in an internal medicine program, and 21% were in an obstetrics and gynecology program
Summary
One in two older women and one in three older men will experience osteoporosis-related fractures in their remaining lifetimes.[1]. Rigorous evidence-based guidelines are available regarding screening and treatment of osteoporosis. Despite evidence-based guidelines and available medical therapies, there is serious undertreatment of osteoporosis in the US. 1 of 12 n drug treatment, who does not, and why, in addition to examining patient and provider attitudes regarding osteoporotic drug therapy.[4] we hypothesize that one of the reasons for the “osteoporosis treatment gap” is insufficient exposure of resident physicians in primary care specialties to education regarding osteoporosis management. The goals of this study were to (i) assess resident physicians’ knowledge and competency in osteoporosis management, (ii) compare exposure to education regarding, and comfort level with, osteoporosis training among resident physicians of primary care specialties (internal medicine, family medicine, obstetrics and gynecology), and (iii) identify knowledge gaps in trainee curricula to highlight opportunities for improvement in the education of resident physicians. We hypothesized that certain characteristics would predict higher knowledge level and comfort with osteoporosis: self-identification as female, internal medicine specialty, and higher postgraduate year (PGY) level
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