Metabolic & Endocrine Disease Summit (MEDS) Newsletter

April 2021

Introducing MEDS for 2021: Essential Endocrinology Topics for Essential Clinicians

Diabetes, thyroid conditions, kidney disease, obesity and lipid disorders are all singular non-communicable epidemics and taken together are a global pandemic. In 2021, this is not news. However, more than a decade ago, a pioneering Physician Assistant (PA), Scott Urquhart had a vision; how can cost-effective and high-quality medical care for endocrine related conditions be delivered with a relative national shortage of Endocrinologists? 

Working as an Endocrine PA in a busy practice in West Virginia, he knew first-hand the toll these common endocrine disorders were taking and wanted to make a real and bigger difference. He knew that advance practice providers, Nurse Practitioners and PAs teaming up with physicians held the answer to the ever-expanding patient care void. He had his endgame in sight but needed other players on board to bring it to fruition.

Fortunately, he discovered a willing and progressive partner and MEDS – Metabolic & Endocrine Disease Summit was born. This partnership was the beginning of a now ten-year success story of bringing practical endocrine management strategies to NPs and PAs working in primary care and other related specialty offices across the country. An aggressive presentation schedule was implemented with MEDS offered twice a year in family-friendly venues (what better way to bring together primary care clinicians). As pharmacotherapeutics and technology were taking off, clinicians needed to be ahead of the curve, and just as important, needed to build and assure their confidence in safely and efficiently applying these treatment game-changers. Scott was proven right, as a capacity crowd filled the room for the first ever MEDS in Orlando, Florida. 

As the vision took shape, selecting the right faculty was imperative. Faculty needed advanced knowledge and experience, along with excellent translational skills. With a high bar, MEDS faculty focused on the mantra of translating the complex language of endocrine; the why, who, how, and when of endocrine disorders into practical, doable advice for dedicated clinicians to carry back to their offices.

Scott collaborated with Christine Kessler, an NP leader in the endocrine community to draw experts in diabetes, disorders of the thyroid, adrenal, bone, and pituitary as well as lipids, nutrition, PCOS, and testosterone. Both CME and non-CME learning were included to achieve affordable registration fees and bring the newest options to the Summit.

As MEDS enters its eleventh year, the physician-NP-PA team has markedly expanded as MEDS’ “graduates” spread out across the nation with the word of how great MEDS is and what it does for their patient care capabilities. Since its inception, MEDS has educated over 10,000 clinicians, offering an average of 22 affordable CME/CEUs per Symposium. MEDS anticipates 1000 registrants for its upcoming virtual meeting. Many registrants attend more than once for knowledge updates and refreshers, while friendships flourish with the mutual desire to provide excellent patient care. 

MEDS has been nimble as it partnered with MedscapeLive! to continue its mission. For the present time, it has pivoted to a virtual platform, streamlined its offerings, and continues to engage excellent clinician educators. MEDS offers core endocrine educational offerings coupled with the new and exciting. 
 
Take a sneak peek at the lecture and case-based learning topics of MEDS 2021 for July and October – you’ll see there is nothing static or boring about endocrinology! The Agenda may be found here.

— Ellen D. Mandel, DMH, MS, PA-C, RDN

 

Interview
Meet Rick Pope PA-C

Rick Pope, PA-C, a founding MEDS lecturer will join us again for our July 2021 virtual symposium.  His topic: “Osteoporosis – Who We Screen, Who Needs Bone-Density? FRAX, and Current Recommendations for Therapy” is not just for “boneheads,” a term Rick uses with the utmost respect.  Indeed, osteoporosis (OP), defined by a statistically significant loss of bone mineral density, leads to significant morbidity, mortality and is commonly seen in both Primary Care and Rheumatology/Endocrine practices.

Rick should know, he spent the bulk of his 30-plus year clinical career as a Rheumatology PA, having been recruited away from Pediatrics by a Rheumatologist desiring a PA in his practice. Rick presently teaches rheumatology topics to all five Connecticut PA programs as well as DNP students at the University of California (Irvine). He notes that the American College of Rheumatology now endorses hiring NPs and PAs due to a long-standing, nationwide shortage of Rheumatologists.  The rising numbers of OP cannot be ignored. The National Osteoporosis Foundation (NOF) reports that 10 million Americans have OP and another 44 million have low bone density, placing them at risk for future OP: it is estimated to be responsible for 3 million fractures costing greater than $25 billion by 2025. As OP numbers continue to rise, primary care clinicians can tackle its diagnosis and management; Rick aims to tell us how.

OP treatment options have continued to evolve, with real advancements in the past few years, moving beyond bisphosphonates, a decade’s old drug. Rick explains that proper diagnosis and treatment is like a bone matrix, a puzzle of sorts whereby patients’ age, gender, ethnicity, activity pattern, smoking history, calcium, and vitamin D intakes along with socio-economic status all come together to formulate risk and help direct treatment strategies.  It is more than just adequate vitamin D and calcium intake.  He specifically wants to dispel the myth that hip fracture, or any OP related fracture  (i.e. Colles, vertebral) is simply bad luck.  Social determinants of health, a long-ignored concept plays an impactful role in OP.  Rick points out that lifelong habits, as well as medical IQ affect OP risk.  How do people learn about OP prevention, find a clinician and learn the right questions to ask to secure their own best care?  Medically trained people have a high medical IQ, not so of most people.  This supports his desire to educate NPs and PAs with MEDS.

There are a number of key updates to OP pharmacotherapeutics, which will be detailed at the upcoming MEDS.  Rick will describe the recent (November 2020) removal of the FDA’s Black Box warning on teriparatide (Bonsity, Forteo) for patients using this PTH analog. Although the two-year use maximum has been removed, just how long they can be used remains open. Think bone markers!

Another OP concern has been balancing the risk of fragility fracture with the risk of atypical femur fracture with long-term bisphosphonate therapy. A 2020 publication in the New England Journal of Medicine followed >197,000 women (Kaiser Permanente) over the age of 50 years for a ten-year period and provides answers to this key question with some unexpected results.  Rick will detail a helpful response to your patients’ questions about long-term risks of bisphosphonate therapy and ethnicity’s role. 

Another question often posed by patients with existing OP relates to the risk of high impact exercise. Will it promote fractures, worsen osteopenia, or provide benefit?  A recently published Australian study in the Journal of Bone and Mineral Research, examines the impact of high-intensity resistance and impact training’s effect on bone mineral density, as well as physical function in postmenopausal women with both osteopenia and OP. Rick will explain how the results of this LIFTMOR study may impact exercise decisions. 

If you think OP is a dull topic, there are new, literally hot-off-the-press screening guidelines issued by the United States Preventive Services Task Force (USPSTF) for vitamin D.  Rick has a lot to say about these guidelines and plans to review their translation and application for the general population versus those with OP.  For example, which form of vitamin D (D2 or D3) might be more beneficial? There is so much to learn about bone health and Rick plans to cover as much terrain as possible.  His lecture style converts complicated concepts to advice you can take back to your office.  Rick continues to crack the code of bone health, helping to ease patient conversation and provide the best treatment options. 

References: 

1. Osteoporosis – Fast Facts.pdf

https://cdn.nof.org/wp-content/uploads/2015/12/Osteoporosis-Fast-Facts.pdf
Accessed 20140222.

2. Highlights of Prescribing Information: Forteo.  Forteo-pi.pdf  Accessed 20210422.

3. Black DM, Geiger EJ, Eastell R, et al. Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates. New England Journal of Medicine. 2020:383(8);743-53.

4. Watson SL, Weeks BK, Weis LJ, et al. High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research. 2018;33(2):211-220. 

5. Screening for Vitamin D Deficiency in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2021:325(14);1436-1442.

— Ellen D. Mandel, DMH, MS, PA-C, RDN