Carilion Clinic News

A Multi-disciplinary Approach from Carilion Clinic's Bone Health Clinic

By Lisa D. Wright, DNP; Jonathan Carmouche, MD; Trevor Owen, MD

As a provider in the Bone Health Clinic, operational since October 2017, our mission is aligned to secondary fracture prevention and improving the bone health of our patients. We provide a multi-disciplinary approach to patient care, connecting with several local experts who share our mission and values, with the intent of building expertise within the network. This infrastructure has been very helpful, as there have been complex patients that required our services. Whether it was a rare bone disease, discovery of cancers or parathyroid adenomas, we leveraged the assistance of these experts. In turn, as a team, we have learned from each other and strengthened our knowledge base of osteoporosis and disorders that affect bone health.

Our multi-disciplinary team has included consults with: Hematology/Oncology, Nephrology, Endocrinology, Vascular Surgery, Bariatric Medicine, Dental Services, Nutritionist, and Physical Therapy.

Between October 2017 to December 2018 we consulted 600 unique patients within our clinic.

The most common referrals were to the following departments:

Hematology/Oncology (MGUS, multiple myeloma)
Vascular Surgery (parathyroid adenomas and thyroid cancer)
Nephrology (evaluate abnormalities of kidney function prior to starting patients on selective therapies)
Bariatric Surgery (malabsorption and poor bone health)
Dental Services (all patients should be appropriately screened for dental history and receive a dental check up with the appropriate screening and treatment prior to starting an antiresorptive therapy. Identification of the local network of dental providers who provide low cost or sliding scale clinics was essential as many of our patients over the age of 65 do not have dental benefits).

Despite our network, we have been challenged on occasion with complex patients and sought the knowledge of national bone health experts. Fortunately, we learned of a team-based learning interactive opportunity to present these cases and we participate weekly on these forums.

We have received good feedback from our patients regarding this holistic approach to management of their osteoporosis as a longitudinal plan of care of a chronic condition.

Our future goals will be to continue to expand our knowledge and align a cross-disciplined bone health presentation at a state or national conference.

If you would like to learn more about our bone health clinic, feel free to contact us at ldwright1@carilionclinic.org.