Clinical Innovations in Rheumatology – Expanding Access to Specialty Osteoporosis Care Through a Virtual Clinic

Carolyn M. Casey, DO, clinical assistant professor of Medicine in the UPMC Division of Rheumatology and Clinical Immunology, is leading a fully virtual osteoporosis clinic designed to increase access to specialty care for patients facing a new diagnosis of osteoporosis or who are being managed longitudinally. Dr. Casey’s virtual clinic is in its second full year of operation. The clinic has evolved from, and is a natural extension of, Dr. Casey’s broader work in virtual and remote rheumatology care. The osteoporosis clinic, which operates entirely through telemedicine evolved in response to clear gaps in access and education among older adults and those living in rural or distant regions far from subspecialty practices.

“I’ve been passionate about reaching patients in rural areas since medical school,” says Dr. Casey. “That commitment shaped my transition to a fully virtual practice three years ago, both in rheumatology and osteoporosis care.”

Dr. Casey’s virtual clinic operates as part of broader, long-standing multidisciplinary osteoporosis efforts at UPMC with partners in the Division of Geriatric Medicine and Division of Endocrinology and Metabolism. Dr. Casey’s virtual clinic serves patients referred from across UPMC, including primary care, rheumatology, geriatrics, and orthopaedic surgery.

“Osteoporosis is one of those conditions that frequently falls through the cracks. Many patients do not recognize the importance of a diagnosis and timely treatment until after a fracture has occurred. And in many cases, underlying osteoporosis is only uncovered after someone sustains a fracture” Dr. Casey says. “That is the clinical scenario we really need to avoid in this patient population because these osteoporotic or fragility fractures often have poor outcomes and can have profound effects on quality of life and mobility.”

Creating a Resource to Fill in Clinical Gaps for Underserved Patient Populations

Osteoporosis often goes underdiagnosed and is undertreated. Even when patients have bone density screenings, follow-up care can be inconsistent or delayed, particularly when a local specialist or clinic is not regularly accessible or even in existence in close proximity to the patient. Dr. Casey’s clinic is designed to close these gaps through proactive evaluation, counseling, and longitudinal management delivered directly to patients in their homes.

“There is a misperception that older adults are unable to manage virtual visits due to technological limitations, but that has not been my experience,” Dr. Casey says. “Most of my patients are successful in accessing care virtually, often with assistance from a family member. In fact, many are empowered by the process in my experience doing this kind of remote patient care.”

First-time patient visits typically last an hour and focus on education, risk assessment, and treatment planning. Follow-up appointments are scheduled annually or as needed based on the patient’s disease status and treatment requirements. A dedicated clinic nurse provides support in ensuring continuity of care, coordinating laboratory testing medication administration, and managing logistical issues related to prescriptions and local care.

“Continuity for our patients is a priority, and our clinic nurse helps patients complete labs on time, prevent medication delays, and coordinate injections or infusions close to home, when possible, so treatment is not disrupted,” Dr. Casey says.

Time-Intensive Care Requires Specialized Attention

Osteoporosis management is time-intensive. It requires extensive discussion and shared decision-making when patients have an incomplete knowledge of their osteoporosis or negative perceptions about the disease and the currently available treatment options. Misinformation in the media and earlier misinterpretations of scientific literature have contributed to confusion and hesitancy about pharmacologic therapy.

“A substantial part of my job with newly diagnosed patients is addressing misinformation and helping patients understand their risks and options,” Dr. Casey says. “There is often a long conversation about why a bone density screen was done, what osteoporosis really is, and what the consequences of not treating the disease can look like.”

Dr. Casey’s educational process includes a review of bone health basics, personalized fracture risk assessment, and guidance on lifestyle and pharmacologic interventions. It also covers the roles of calcium and vitamin D supplementation, overall nutrition, body weight, and safe exercise practices, tailoring these recommendations to each patient’s environment and abilities, as well as their goals of care.

“We try to incorporate everything from walking routines to awareness of high-risk activities,” Dr. Casey says. “While there are excellent programs for osteoporosis education, rural areas or patients with travel and mobility barriers often lack access to those resources, which is why individualized counseling during my virtual visits is so important.”

Fracture Prevention and the Value of Early Intervention

The primary goal of osteoporosis management is to prevent fractures before they occur. Fractures in older adults can lead to prolonged immobility, chronic pain, and increased mortality when it comes to hip fractures or more complex fracture patterns in the lower extremities. For an individual with osteoporosis, even a minor event such as sneezing, lifting a grandchild, or performing an exercise their bones cannot handle can cause vertebral compression fractures in patients with advanced disease.

“Patients are often surprised to learn that osteoporosis is silent and that they could be at risk for a serious fracture without experiencing any symptoms and through normal everyday activities, not just a catastrophic fall or high-energy trauma,” Dr. Casey says. “The reality is, by the time a fracture occurs, the damage is already done. This is the primary reason we want to intervene early and mitigate the risk of fracture to the fullest extent possible. It’s taxing on the body to heal from a fracture, even in younger individuals, and more so in older adults who have less physical resilience and often have multiple chronic comorbidities that complicate the recovery process.”

Risk stratification tools that factor in variables, including prior corticosteroid use, rheumatoid arthritis, family history, and fall risk help guide decision-making in the clinic. In the majority of cases, treatment plans are built around risk reduction instead of complete reversal of the disease process.

In the Ideation Stage: A Virtual Fracture Liaison Service

In addition to her virtual osteoporosis clinic, Dr. Casey is exploring the possibility of creating a fully virtual fracture liaison service that could be deployed across the UPMC system. While some hospitals within UPMC already have in-person fracture liaison programs in place that have proven effective, there is still potential for broader reach through a virtual platform.

“Postfracture patients are at high risk for another fracture and poor long-term outcomes, yet many never receive osteoporosis evaluation or treatment after the first fracture,” Dr. Casey says. “A virtual liaison service could systematically capture these patients across the system and connect them to more timely screening, education, and follow-up care,” Dr. Casey says.

Patient Referrals and Consultations

• UPMC Arthritis and Autoimmunity Center – 412-946-2908
• UPMC Center for Osteoporosis and Metabolic Bone Disease – 412-692-4200

References and Further Reading

• Moriarty A, Boland B, Yadav P, Shah N, Curtis JR, Curtis J. Remote management of osteoporosis. Bone Rep. 2021; 5: 101102.
• Ralston SH, Curtis EM, Fraser A, et al. Osteoporosis in 2022: Care gaps to screening and personalised medicine. Nat Rev Endocrinol. 2022; 18(12): 757–766.
• International Osteoporosis Foundation. Pilot study highlights critical gaps in patients’ osteoporosis awareness and management. Published March 4, 2022. Accessed September 30, 2025.
• Ralston SH, Compston JE. Effective communication and the osteoporosis care gap. J Bone Miner Res. 2022; 37(8): 1451–1453.
• Vallejo-Baez S, Yamamoto S, Martínez-Millana A, et al. Telemedicine for osteoporosis follow-up: clinical effectiveness and patient satisfaction. Research Square. Preprint. Posted June 20, 2023.
• Loeser RF, Goldring MB, Scanzello CR, et al. Addressing the growing burden of musculoskeletal diseases in the ageing US population: challenges and innovations. Lancet Healthy Longev. 2022; 3(6): e402–e409.
• Yong EL, Goh L, Tai BC, et al. Virtual fracture liaison clinics in the COVID era: an initiative to maintain fracture prevention services during the pandemic associated with positive patient experience. Arch Osteoporos. 2022; 17(1): 78.