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Collaborative Staff: Drs. Robert Josse, Tim Murray, Sophie Jamal (Division of Endocrinology, Michael's Hospital)
Where: Metabolic Bone Disease/Osteoporosis
Ambulatory Clinic, 61 Queen
Street, 7th Floor Centre for
Diabetes and Osteoporosis
When: Monday AM (8-12noon) with seminar/discussion group (lunch provided 12-1pm)
Number and types of patients:
There will be a mix of new (approximately 2-4) and follow-up patients (5-8) per clinic. The
patients represent the spectrum of primary as well as secondary metabolic
bone disease/osteoporosis. Saint Michael's Hospital is a large tertiary
care institution with active programs in transplantation, bowel disease,
autoimmune rheumatic and other disorders. Drs. Josse, Murray and Jamal
are recognized experts in metabolic bone disease, and will provide a unique
resource for trainees.
Overall Rotation Objective:
Under the direct supervision of Dr. Laurence Rubin, this rotation
is intended to provide a comprehensive, evidenced-based approach
to the assessment, investigation and management of patients
with metabolic bone disease/osteoporosis. As in the past, one
to one teaching will be the norm, and the trainee will have
the opportunity to explore relevant clinical issues in a formal
and informal manner. Additional opportunities exist for research/elective
rotations in clinical and basic research, including lab-based
programs involving associate staff (see below).
In particular, this specific site and rotation will provide
the rheumatology fellow with a wide exposure to a variety of
metabolic bone diseases. While osteoporosis on a primary and
secondary (drug induced, secondary to inflammatory disorders)
will make up a large portion of the patients seen, there will
be a spectrum of other conditions assessed, including genetic
metabolic bone disease, acquired osteodystrophy, and disorders
of calcium mineral metabolism.
A seminar/discussion group will follow (lunch provided) each
session. SMH radiology (Dowdell, Pearce) and Orthopedic (Bogoch)
staff participate, and a regular radiology session is planned
to review the imaging components relevant to Metabolic Bone
disease such as Hyperparathyroidism, Paget’s, osteodystrophy,
fracture, and novel imaging technologies.
Specific Aims:
- Develop appropriate skills in focused history and physical
exam of patients with
metabolic bone disease/osteoporosis.
- Interpretation of laboratory results and indications for
additional studies,
including those related specifically to calcium mineral metabolism,
metabolic bone disease.
- Interpretation of bone densitometry results and ability
to communicate this
data effectively to patients. Saint Michael's has a state of the art Lunar expert system. Drs.
Rubin, Josse, Murray and Jamal all participate in BMD interpretation.
- Evidence-based management of metabolic bone disease/osteoporosis.
- Awareness of the role and contribution of allied health
professionals and other
community resources in the management of such patients.
Trainees will
have the opportunity to explore research projects including case reports,
case series reviews and laboratory experience (metabolic genetic studies),
the latter if time and elective rotations permit.
Collaborators:
Dr. David Cole - Molecular genetic and biochemical studies in MBD (Banting Institute, UHN)
Dr. Reinhold Vieth - Vitamin D biochemistry and metabolism (MSH)
The trainee will also gain expertise in the assessment of bone densitometry (DEXA)
results, and determination of appropriate intervals for follow-up investigations.
An evidence-based approach is the underpinning of therapeutic decisions, but the trainee
will gain insight into novel/experimental regimens as well.
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