Lianne Hirano, M.D.
Career Interest: Dr. Hirano's long term goal is to become a physician scientist and to work as a leader in improving care of older adults.
Research Interest: The goal of Dr. Hirano's research is to better understand the way in which diagnosis and treatment for male osteoporosis is conducted within the VA, in order to assure quality care is being provided to VA patients and to minimize the risk of fractures and the considerable disability and health care costs they incur.
Dr. Hirano is currently conducting a study at the VA Puget Sound Health Care System (VAPSHCS) to quantify the percentage of veterans at high risk for fractures who undergo bone densitometry by DEXA, evaluation for secondary causes of osteoporosis, and who are treated with calcium, vitamin D and bisphosphonates as recommended by national clinical practice guidelines. Preliminary results suggest that a minority of veterans at high risk for fractures (specifically, veterans with a recent history of hip fracture, those who are being treated with high-dose glucocorticoids, and those who are being treated with androgen deprivation therapy for prostate cancer) were evaluated with DEXA scans (6-13 %), had adequate evaluation for secondary causes (e.g., vitamin D deficiency [4-10%]), or received treatment with bisphosphonates (13-15 %).
She also plans to conduct a prospective, randomized, controlled trial, focusing on men with prostate cancer who are started on androgen deprivation therapy at the VAPSHCS as the initial high risk group to test her proposed clinical intervention. The clinical intervention that will be tested is a combination of an order set for diagnosis and initial evaluation of osteoporosis and a simple treatment algorithm used by a non-physician clinic staff person. An electronic “Quick Order” will be created within the electronic ordering system used at the VAPSHCS that will offer (primarily urology) clinicians the opportunity to order a screening DEXA scan and relevant laboratory tests (calcium, phosphate, parathyroid hormone, 25-hydroxy vitamin D level, and testosterone level) when they enter an order for a GnRH agonist (e.g., leuprolide or goserelin), and/or anti-androgen (e.g., bicalutamide). The clinic staff person will inform all urology clinicians who prescribe GnRH agonists and anti-androgens that a new Quick Order has been created to aid in the evaluation for osteoporosis in this high risk patient population. Veterans diagnosed with prostate cancer and started on androgen deprivation therapy will then be randomized to one of two groups: a usual care (control) group and an intervention group. The usual care group will undergo treatment and evaluation solely by the urology clinicians and other clinicians, including primary care practitioners, who have access to results of tests obtained from the Quick Order set. The intervention group will be followed by a clinic registered nurse or pharmacist who will implement an osteoporosis evaluation algorithm that Dr. Hirano has designed. Study subjects will be followed for one year. The primary outcome measure will be appropriate initiation of calcium, vitamin D, and bisphosphonate therapy in men with osteoporosis. Secondary outcomes include the number and percentage of men with a diagnosis of osteoporosis, DEXA scans ordered, and of men who have adequate evaluation of secondary causes of osteoporosis. Other outcomes that Dr. Hirano is interested in exploring include the number and percentage of patients with vitamin D deficiency (as diagnosed by 25-hydroxyvitamin D level) and, of those patients, the number and percentage who have their vitamin D stores repleted adequately.
Education and Training:
College: Bowdoin College
Medical School: Yale University School of Medicine
Residency: University of Washington
Publications: Click to go to PubMed.
Clinic Information: Harborview Medical Center, Palliative Medicine
Harborview Medical Center
325 9th Avenue, Box 359755
Seattle, WA 98104-2499
Phone Number: (206)744-1888
Fax Number: (206)744-9976
Patricia Steel Memorial Bldg.
401 Broadway, 5th Floor, Room 5048
Seattle WA 98122
Phone (206) 744-1888
Fax (206) 744-9976