Episode 45: Osteoporosis Update.
Dr Linares (endocrinologist) explains the basics of screening and treatment of osteoporosis, referring frequently to the updated guidelines of osteoporosis by AACE and ACE (2020). A new group of residents is introduced.
Congratulations to our new group of residents: Amelia Martinez Lopez, Amardeep Singh Chetha, Cecilia Selena Covenas, Funmilayo Helen Idemudia, Licet Imbert Matos, Su Myat Hlaing, Timiiye Dawn Yomi, and Young Na Sung. This group of residents will start in July 2021 and will graduate in July 2024. We hope you enjoy your time with us.
Today is March 22, 2021.
Implanted pacemakers and defibrillators are equipped with a switch that responds to magnetic forces to stop them when needed. Magnetic interference between these cardiac implantable electronic devices (CIEDs) and mobile devices have been investigated for years. It has been established that magnetic fields stronger than 10 gauss can deactivate these cardiac devices, causing pacemakers to give asynchronous pacing and ICDs to stop tachyarrhythmia detection.
The Heart Rhythm Society journal, published in October 2009 (that was 11 years ago), an association between portable headphones and significant electromagnetic interference (EMI) in patients with implantable cardioverter-defibrillators (ICD) and pacemakers (PM).
100 patients with implanted devices were tested with different portable headphones. Headphones effectively deactivated implanted devices when held less than 2 cm from skin on the left side of chest. There was not interference when headphones were placed farther than 3 cm. In this study, normal functioning of the devices was restored in 29 out of 30 cases when the headphones were removed from the patient’s chest. The recommendation from that study was to recommend patients to keep their portable headphones at least 3 cm away from their implanted device.
More recently, in January 2021, the same journal posted the effect of iPhone 12 on ICDs deactivation. iPhone 12 and MagSafe technology, which allows faster wireless charging, contain strong magnets. iPhone 12 successfully deactivated a Medtronic Inc. ICD when tested by a group of investigators in a patient[2].
The official Apple Support website posted on February 25, 2021, “To avoid any potential interactions with these devices, keep your iPhone and MagSafe accessories a safe distance away from your device (more than 6 inches / 15 cm apart or more than 12 inches / 30 cm apart if wirelessly charging)”[3]. Other devices such as fitness tracker wristbands, and even e-cigarettes have been involved in deactivation of ICDs.
Bottom line: Make sure your patient discusses with you or their cardiologist before buying wearable or mobile technology that may interfere with their implanted cardiovascular devices.
This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.
“The secret of getting ahead is getting started” —Mark Twain.
Osteoporosis Update
During this conversation, we discussed some parts of the guidelines from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE)[2], updated in 2020. This is not a complete analysis of those guidelines. For a comprehensive explanation of the guidelines, visit the AACE or ACE websites. The recommendations from these organizations may be different than the ones given by the American Academy of Family Physicians (AAFP) or the United States Preventive Services Taskforce (USPSTF), which are organizations we are more familiar with as family physicians.
The questions analyzed during this conversation includes:
When would you consider a DEXA scan to screen a woman younger than 65 for osteoporosis?
What to do when the report says Osteopenia (T score -1.0 to -2.5)? Let’s mention the recommended dose of Vitamin D and Calcium.
What is the FRAX score?
What is an easy work up we can do to rule out a secondary cause of osteoporosis before sending patient to you?
The new guidelines divide patients in two categories: “High risk/no risk of fractures” and “VERY High risk/prior fractures”, What’s the difference in management between those two categories? (alendronate in high risk vs abaloparatide in very high risk).
How can you tell the patient has a good response after 1 year of treatment (Dexa scan, bone turnover markers)? What is a drug holiday?
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Now we conclude our episode number 45 “Osteoporosis Update”. Dr Linares explained what the FRAX score is and mentioned the different options we have for treatment of osteoporosis. DEXA scan continues to be the gold standard for screening, diagnosis and monitoring of osteoporosis. We will announce the winner of the question of the month about polyarthralgia next week, and we wish our new group of residents a great start in July 2021. Remember, even without trying, every night you go to bed being a little wiser.
Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Maria Linares, and Claudia Carranza. Audio edition: Suraj Amrutia. See you next week!
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References:
Lee S, Fu K, Kohno T, Ransford B, Maisel WH. Clinically significant magnetic interference of implanted cardiac devices by portable headphones. Heart Rhythm. 2009 Oct;6(10):1432-6. doi: 10.1016/j.hrthm.2009.07.003. Epub 2009 Jul 8. PMID: 19968922. https://www.heartrhythmjournal.com/article/S1547-5271(09)00740-1/fulltext
Greenberg, Joshua C.; Mahmoud R. Altawil; Gurjit Singh; Letter to the Editor—Lifesaving Therapy Inhibition by Phones Containing Magnets, Heart Rhythm, January 04, 2021. DOI:https://doi.org/10.1016/j.hrthm.2020.12.032. https://www.heartrhythmjournal.com/article/S1547-5271(20)31227-3/fulltext
“About the magnets inside iPhone 12, iPhone 12 mini, iPhone 12 Pro, iPhone 12 Pro Max, and MagSafe accessories”, Apple Support, https://support.apple.com/en-us/HT211900, accessed on March 2, 2021.
AACE Releases 2020 Clinical Practice Guidelines for Postmenopausal Osteoporosis, Physician Weekly, September 11, 2020, https://www.physiciansweekly.com/aace-releases-2020-update-clinical-practice-guidelines-for-postmenopausal-osteoporosis/
