A proactive approach to bone care

Four years ago, Kathryn M. Diemer, M.D., was riding her Irish thoroughbred horse, Patronus, when he suddenly bolted. Diemer fell and broke her back.

As a physician, she always had felt empathy toward her patients with osteoporosis, a disease that breaks down tissue in bones. But her fall only heightened her sense of sympathy.

“I had the most common fracture that my patients have, and I had never been in so much pain,” says Diemer, assistant professor of medicine and assistant dean for career counseling. “Now I really understand what they’re going through.”

Compassion, contagious enthusiasm and training at Washington University with top bone clinicians helped Diemer become a leader in her field, her colleagues say.

“She is a defining member of our musculoskeletal team and among the best bone clinicians in the country,” says Steven L. Teitelbaum, M.D., the Wilma and Roswell Messing Professor of Pathology and Immunology. “She’s the person you want to take care of your mother or your wife with osteoporosis.”

During an internship and residency in medicine at Jewish Hospital of St. Louis, Diemer became interested in osteoporosis and was fortunate to learn from Louis Avioli, M.D., then head of the Division of Bone and Mineral Diseases.

“I was definitely in the right place at the right time,” Diemer says. “I don’t think people even realized that some of the biggest names of bone and mineral research are either still here or trained here.”

Diemer also earns kudos as assistant dean of career counseling, in which she advises students when they’re choosing their specialties and applying for residencies. Leslie E. Kahl, M.D., professor of medicine and associate dean for student affairs, says Diemer balances her two very different jobs with aplomb.

“In Kathy’s role as assistant dean, she is a wonderful advocate for our medical students,” Kahl says. “She provides students with detailed information specific to their own specialty plans and just as important, mentors them through the application and interview process.”

Liza Harrison, now a resident in pediatrics at St. Louis Children’s Hospital, says Diemer knows the process backward and forward and is able to pass along her vast experience to all 120 medical students.

“She really goes to bat for us, including making personal phone calls across the country to do what she can to help us match at our first-choice programs,” Harrison says.

Diemer, who always was interested in animals, thought she would become a veterinarian. She and her four sisters spent Saturday mornings at the Saint Louis Zoo with her father, a local judge who was on the zoo’s board of directors. Eventually, Diemer worked at the zoo, selling balloons and snowcones for a few years before becoming a part-time zookeeper in the Children’s Zoo during high school.

But Diemer’s identical twin, Pat, wanted to become a doctor and talked Diemer into applying to the six-year medical school program at the University of Missouri-Kansas City.

Diemer and her sister both were accepted and thrived in the program, graduating from medi-cal school when they were 23 years old.

“We didn’t have the pressure of pre-med because we were already in,” Diemer says. “There were expectations that we have certain grade-point averages, but we were all in it together. We all kind of grew up together.”

During an internship in obstetrics and gynecology at Truman Medical Center in Kansas City, Diemer discovered that she didn’t want to deliver babies for a living. So she decided to do another internship and a residency in medicine at the same time Pat was completing a surgery residency at Jewish Hospital.

“It confused many medical students and patients,” Diemer says. “Medical students would just be doing something with Pat on surgery, and then I’d get in the elevator with them. It also confused patients if we were consulting on the same ones.”

When Diemer joined the Division of Bone and Mineral Diseases in 1990, physicians in the bone health clinic mostly saw patients with osteoporosis who’d already had their first fractures.

“We didn’t have that much to offer for these patients besides estrogen and tips on preventing falls,” Diemer says. “Bone-density testing was just getting started.”

Bone-density testing now is recommended for all women older than 65. According to the National Osteoporosis Foundation, 10 million people have the disease and almost 34 million are estimated to have low bone mass, placing them at increased risk for osteoporosis. Of the 10 million Americans who have osteoporosis, eight million are women.

Today, each of Diemer’s patients gets a bone-density test, and the treatment options have greatly expanded, ranging from the popular drug Fosamax to a once-a-month pill called Boniva. On the horizon is an osteoporosis drug that will be taken just once a year.

She sees patients who have normal bone density but are having fractures, and patients with low bone density who have never had fractures.

Many of Diemer’s patients don’t want to take medication or they want to try alternative therapies.

“I’ll tell them that they have a year to try those things,” she says. “But if their bone density decreases or if they have a fracture, I tell them we have to use proven therapies.”

She and her colleagues also spend a great deal of time educating patients. They recommend daily doses of calcium and vitamin D and at least 20 minutes a day of walking.

And what’s the greatest myth about osteoporosis?

“Many people think that once they’ve had a fracture, we can’t do anything,” Diemer says. “That’s just not true. There are many things we can try.”

Roberto Civitelli, M.D., the Sydney M. and Stella H. Schoenberg Professor of Medicine, professor of orthopaedic surgery and of cell biology and physiology, met Diemer when she was a chief resident in medicine at Jewish Hospital. He said she embodies the essence of a highly specialized academic physician.

“Aside from her experience and skills as a physician, some of [her] best qualities are her continued interest in metabolic bone diseases and her pro-active approach to challenges while still being involved in teaching opportunities and having a life and family on the side,” Civitelli says.

Diemer’s husband, David, is a radiologist at Missouri Baptist Medical Center. Her daughter, Anne E., is an eighth-grader at John Burroughs School, and her son, Daniel is a fifth-grader at the Community School.

Diemer has many outside interests, including volunteering at her children’s schools, cooking and scuba diving with her family. And despite her fall, she still rides her horse a few times a week on trails in Babler State Park.

The best parts of her job, she says, are handing out envelopes on Match Day and feeling as if she’s been able to keep some of her long-term patients independent and out of nursing homes.

“I’ve taken care of some of these patients forever,” she says.

And Diemer, who says she is glad she became a physician instead of a veterinarian, greatly enjoys the diversity of her work schedule.

“I like switching from patients to students to teaching,” she says. “My husband says I’m the only person he knows who loves her job.”