Rheumatology trainees' experience of osteoporosis and metabolic bone disease: a uk-wide survey

Abstract Background/Aims The 2022 rheumatology curriculum requires trainees to achieve competence in the management of osteoporosis and a number of metabolic bone diseases by the end of their training. In addition, the recent 2022 NOGG guidance states that very high-risk osteoporosis patients should be considered for referral to specialist care. Hence there is a need to ensure high quality training in this area. We aimed to assess rheumatology trainees’ experience of osteoporosis and metabolic bone disease. Methods A Google form was designed, comprising questions relating to experience of and confidence in managing osteoporosis and other metabolic bone disease. A completion link was circulated to rheumatology trainees via regional trainee representatives. Reminders were sent at intervals during the survey period. Trainees completed the survey anonymously. Results 41 trainees responded. Training grade ranged from ST4-ST7, with 1 specialty doctor and 1 individual who had completed training. Six regions in England, plus Wales and Northern Ireland were represented. 23 trainees (56.1%) reported having observed at least one osteoporosis clinic, and 18 (43.9%) reported having participated in an osteoporosis clinic on a weekly basis for at least 12 weeks. Fewer trainees (11, 26.8%) had observed a specialist metabolic bone disease clinic, and 9 (22%) had participated in one. In terms of exposure to individual conditions, 31 trainees (75.6%) reported clinical experience of managing postmenopausal osteoporosis and 29 (70.7%) reported experience of managing Paget’s disease. Exposure to rarer metabolic bone diseases was much lower, with over half reporting no clinical experience of: osteomalacia; osteonecrosis; bone marrow oedema syndromes; hypophosphatasia; osteogenesis imperfecta; fibrous dysplasia; or FGF-23 mediated osteomalacia. 12 trainees (29.3%) had experience reporting DXA scans. Table 1 summarises trainees’ confidence levels across a number of areas. Overall, 9 (22%) rated their confidence in assessing and managing patients with osteoporosis and metabolic bone disease as equal to or higher than for patients with inflammatory arthritis. 22% said they were likely or very likely to consider sub-specialising in osteoporosis/metabolic bone disease. Conclusion Our survey has identified significant variations in training, particularly for rarer metabolic bone diseases. However, despite this, the sub-specialty appears to remain an attractive career option. Disclosure S.A. Hardcastle: None. M. Rutter: Other; M.R. is a Versus Arthritis Clinical Research Fellow and Chair of the BSR trainee committee. Z. Paskins: Consultancies; Unpaid consultancy for non promotional activity with UCB.