Dr. Elnekave: What were the defining experiences which compelled you to dedicate your professional life as a consultant Rheumatologist to the issue of bone health & osteoporosis?
Dr. Javaid: Rheumatology covers a wide range of diseases across the lifecourse. My interest in bone health was sparked by working with an inspirational professor that then led to me to complete a PhD in the field. Additionally osteoporosis allows interplay between epidemiology, biological processes, therapies and heatlh services research as well as interactions with multple other medical and surgical specialties.
Dr. Elnekave: What is the impact of the FLS – on individuals, family, on physicians and the healthcare system?
Dr. Javaid: There is a crisis in osteoporosis management globally. In the UK only 20% of paitents receive any sort of secondary fracture prevention after a fragility fracture. Fracture Liaison Services (FLSs) are commissioned to close this care gap and prevent avoidable fractures through systematic identification, investigation, intiation and monitoring of therapy of patients after the first fragility fracture. The aim is to stop at one.
For patients, avoiding a hip fracture avoids a 30% mortality and 50% loss of the ability to climb stairs. The family avoids the need to restructure / re-house their relatives (50% enter long term care homes). By avoiding frailty fractures, physicians gain a greater capacity to focus on other emergency admissions as well as elective care (fragility fractures take up more bed days than myocardial infarction and stroke); for the health care system the avoided fractures reduce bed days needed and social care home resources
Dr. Elnekave: Along the lines above, how does FLS benefit the community – specifically can you describe the financial impact of FLS?
Dr. Javaid: Effective FLSs in the UK are cost effective within 24 months and in the Oxfordshire region with a popluation of 620,000 will lead to a projected £5.3 million saving in health and social care costs after 5 years.
Dr. Elnekave: How do you envision machine learning integrating with clinical care in this context? How might machines help people focus on what they do best and improve outcomes?
Dr. Javaid: A key fracture type is vertebral fracures. These fractures carry one of the highest risks for re-fractures at the vertebra as well as other sites in addition to be being the most responsive to therapy. However, most verteral fractures do not come to clinical attention.
A key pathway for identification is through opportunistic screening of existing cross sectional images requested for any original clinical indication. A number of audits and surveys have documented sub-optimal identification of these vertebral fractures by the radiologists. Given the rising number of images and the mis-match with radiology specialist staff, the potential of machine learning to identify not only vertebral fractures but also estimate the bone mineral density of the lumbar veretebra is a potential game changer in the pathway for these patients.
Dr. Elnekave: How do you feel about us (Zebra)?
Dr. Javaid: In the short time I have worked with Zebra, I am impressed with their transparency and strong vision to provide game changing solutions to the problems we face within healthcare.