As a professor, Natasha Appelman-Dijkstra understands better than anyone how important it is to recognise bone and mineral conditions at an early stage. She emphasises the importance of flexibility and collaboration for better care, groundbreaking research and strong education.
Appelman-Dijkstra: 'My chair is about internal medicine, particularly bone and mineral disorders. Rare ones, but also more common ones, such as osteoporosis. It is often thought that a wrist fracture in someone over the age of fifty is something that "can happen". But that couldn't be further from the truth. One in three women and one in five men suffer from bone decalcification, also known as osteoporosis. This causes a huge reduction in quality of life. We also know that people who have a hip or vertebral fracture are more likely to die earlier, regardless of any other diseases they may have. It is very important that people realise this and that we take proactive action to tackle it.'
'As an academic centre, we investigate new forms of diagnostics and treatments for common bone disorders. We are also a centre of expertise for people with rare bone and mineral disorders. In the Netherlands, there may be only 20 people with a particular disorder, but across Europe there may be as many as 200. That is why we have set up a large European database for rare hormone and bone disorders. This enables groundbreaking research to be carried out and new guidelines to be established. Currently, 160 centres from 35 countries are affiliated with this registry.'
The right care in the right place
Appelman-Dijkstra believes in care close to home: 'There are actually very few centres of expertise in the Netherlands for bone and mineral disorders. Sometimes patients come to us all the way from Groningen. If you're unlucky, you also get stuck in traffic and it takes you 3.5 hours to get here, all for a 20-minute appointment. Most people have a skeletal condition, which means they spend those 3.5 hours driving in pain. That is terribly unpleasant for a patient. If we ensure that patients can attend most of their appointments in familiar surroundings, with us as an academic centre playing a more advisory role, then patients only have to make that journey once or twice a year. This also offers us, as doctors, flexible options. If you can view the scans or blood test results from other hospitals in advance, you could, for example, conduct a video consultation from home. These digital possibilities contribute to a better work-life balance.'
Looking beyond boundaries
She is proud of many things, but especially of the excellent collaboration with other specialisms: 'One example is the collaboration on fibrous dysplasia. This is a rare disease in which healthy bone is replaced locally by diseased (fibrous) bone. This leads to weak bones that can break or deform easily. Depending on where the abnormality is located, you will be referred to a specific specialist. This could be an orthopaedic surgeon, ophthalmologist or internist-endocrinologist if it is associated with a hormonal disorder or needs to be treated with medication.'
'We have combined the strengths of various specialisms in research, healthcare and education. Over the years, we have taken on several PhD students who have conducted and continue to conduct research into fibrous dysplasia from different disciplines. We have also started joint consultation hours. Initially once every two months, this has now increased to twice a month. Patients from all parts of the Netherlands are seen on a single day by the internist-endocrinologist and orthopaedic surgeon/ophthalmologist/oral surgeon together. If necessary, they are also seen by an ENT specialist or paediatrician, and we perform a special bone scan, known as a PET scan. Thanks to this collaboration, our research into fibrous dysplasia is among the best in the world. There is now even an international partnership for this condition, of which I am the coordinator. Within this partnership, researchers, clinicians and patient associations work together. We incorporate this knowledge and experience into our teaching to ensure that the collaboration is also successful here, by means of a joint lecture with orthopaedics.'
'Another example is the Osteoporosis Care Track. Together with trauma surgery and orthopaedics, we have set up a very effective treatment programme that has been operating for several years now. This enables us to screen people over the age of 50 who come in with a bone fracture for osteoporosis at an earlier stage. This screening enables us to start treatment in a very early stage and provides us with a large amount of patient data. With this knowledge, we can conduct innovative research and provide high-quality education.'
Passion for education
Education is a great passion for Dijkstra-Appelman. Since 2022, she has also been head trainer for Internal Medicine in the Leiden Education and Training Region: 'Education is important for all specialisms, but especially for bone and mineral disorders. Education makes it clear why it is important to continue to look at this proactively. Of course, students don't need to know everything about all disorders, but they do need to know what to be aware of and how to get the right help.'
'I hope we can continue to inspire students to pursue careers in hospitals. There are barely any other workplaces that combine healthcare, research, and education. Of course, you often read about high work pressure. In hospitals, there are always important matters that demand your attention. It is important to teach students, as well as specialists in training, how to deal with this flexibly. How they can prioritise and use digital developments to their advantage, without losing personal contact.'
Looking forward
She has a clear vision for the future: 'I hope that we can continue to expand the research registry. Ultimately, I hope that every patient can be automatically entered into the registry, enabling us to provide better predictions of what will happen in the consultation room and offering better treatment options for the many rare bone and mineral disorders.'
'I also hope that the current collaborations within the LUMC and beyond can be strengthened and that we can provide better care by consulting each other more often. People are living longer and increasingly suffer from multiple illnesses. I hope that, as professionals, we can more easily look beyond our own boundaries and perhaps even remove those boundaries from time to time if necessary for the patient. In doing so, it is important to regain some flexibility, as long as the quality remains high.'
Natasha Appelman-Dijkstra's inaugural lecture, entitled "Als de kwaliteit maar goed is", will take place on 12 September in the Lokhortskerk in Leiden and can also be followed live via the livestream on the Leiden University website.
