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Arthritis & Rheumatology Clinic

Contact Information

Arthritis & Rheumatology Clinic

740 Jordan Street, Shreveport, LA 71101

Office: (318) 424-9240

Fax: (318) 424-0022

www.Arthdoc.Com

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About Dr. Goodman

Robert E. Goodman, M.D.

Board-Certified Rheumatologist

"Blending the most innovative approaches in rheumatology and arthritis treatments with personalized patient care"

Board Certified Rheumatologist Robert E. Goodman, M.D., of the Arthritis and Rheumatology Clinic in Shreveport, has been caring for patients in the Ark-La-Tex since 1985. Dr. Goodman combines his specialized training and experience with personalized care to provide patients with leading-edge technology and the latest treatment options.

Dr. Goodman and the Arthritis & Rheumatology Clinic Healthcare Team of caring, compassionate healthcare professionals utilize their expertise and years of experience combined with leading-edge technology and the latest treatments to provide the very best of healthcare.

The Arthritis & Rheumatology Clinic (ARC) is located at 740 Jordan Street in Shreveport, Louisiana. Dr. Goodman and the healthcare professionals at ARC are honored to partner with you in your healthcare.

ARC offers in-house diagnostic services including complete x-ray services, MRI, and state-of-the-art bone densitometry. ARC was the first private practice in Northwest Louisiana to offer bone density testing. For patients' convenience, an onsite phlebotomist is also available for any lab tests that may be required.

Rheumatic diseases and conditions we diagnose and treat at ARC include rheumatoid arthritis, osteoarthritis, osteoporosis, psoriatic arthritis, fibromyalgia, gout, systemic lupus erythematosus (SLE), ankylosing spondylitis, polymyalgia rheumatica, bursitis, tendinitis, carpal tunnel syndrome, polymyositis, sarcoidosis, undifferentiated connective tissue disease, Paget's disease, Raynaud's phenomenon, reflex sympathetic dystrophy, Reiter's syndrome, scleroderma, Sjogren's syndrome, & reactive arthritis among others. There are over 100 different types of arthritis. Dr. Goodman diagnoses and treats them all.

For more information, see our ARC Website at: https://www.Arthdoc.Com. To schedule an appointment, call ARC at 318-424-9240.

Dr. Goodman received his undergraduate degree from LSU in Baton Rouge, and his Medical Degree from LSU School of Medicine in Shreveport. He completed his internship and residency in Internal Medicine at the Medical University of South Carolina in Charleston, and his Rheumatology Fellowship at the University of Tennessee Health Science Center in Memphis, Tennessee.

Dr. Goodman is a member of the Northwest Louisiana Medical Society, Louisiana State Medical Society, American Medical Association, as well as the American College of Rheumatology, American Society of Internal Medicine, and American College of Physicians.

Dr. Goodman received the 2013 Humanitarian Award from Martin Luther King Health Center, where he has been a volunteer and supporter for 35 years. The MLK Health Center & Pharmacy offers comprehensive primary healthcare and pharmacy services at no cost to uninsured or under-insured patients with chronic illness who otherwise often forgo routine medical care because of a lack of resources.

Why Is Osteoporosis An Undervalued Diagnosis Among Men?

Osteoporosis is widely regarded as a silent disease — right up until the moment a bone breaks. It is also widely thought to be a disease that only women need to be wary of, which can lead to dangerous complacency among physicians and male patients alike.

While the majority of cases of osteoporosis are diagnosed among women, men tend to have higher mortality rates and worse functional outcomes following a fragility fracture, and they are twice as likely to die after a hip fracture.1 Osteoporosis clearly presents a significant medical burden, yet screening rates for men are well below satisfactory.

"Osteoporotic fractures are a serious medical concern," said Christopher Morris,MD, senior physician at Arthritis Associates of Kingsport in Kingsport, Tennessee. "There are about 300,000 hip fractures every year, and we have medicines that can reduce the risk of a fracture by 20% to 30%. That would mean a reduction of 50,000 fractures, which is significant."

Current Guidelines

Most current screening guidelines state that men should be screened for osteoporosis by age 70. According to guidance from the Endocrine Society, earlier screenings are indicated for men aged between 50 and 69 years who have risk factors such as delayed puberty, hypogonadism, hyperparathyroidism, hyperthyroidism, or chronic obstructive pulmonary disease. Individuals with a history of smoking or drinking an excessive amount of alcohol, as well as those who receive glucocorticoids or gonadotropin-releasing hormone agonists, should also be screened early.2

In particular, glucocorticoid use is common among patients with inflammatory or respiratory diseases. Glucocorticoid-induced osteoporosis is fairly prevalent among this population. Dr Morris noted that rheumatology experts feel that anyone who is on chronic prednisone should be monitored. This is one area where male patients should be tested regularly.

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We just don't think about men having osteoporosis. But if we don't think about men having it, then men are not going to be tested for it.

In terms of screening modalities, the Endocrine Society guidelines recommend fracture risk calculators such as FRAX and Garvan. Dual-energy x-ray absorptiometry (DXA) of the spine and hip is recommended for men with risk factors. Among men with hyperparathyroidism or those receiving androgen-deprivation therapy for prostate cancer, forearm DXA (⅓ or 33% radius) can be measured if the spine or hip bone mineral density (BMD) cannot be interpreted.2

A thorough medical history that includes details of medication use, chronic diseases, alcohol and tobacco use, previous falls or fractures, and a family history of osteoporosis should be performed, alongside a physical examination that includes balance, mobility, and frailty assessments. If the history and examination are suggestive of a specific cause of osteoporosis, then further testing should be done.2

Current Reality

"We just don't think about men having osteoporosis," said Dr Morris. "But if we don't think about men having it, then men are not going to be tested for it." 

Osteoporosis screening remains low among men, in part due to clinician and patient uncertainty about the role of universal screening in male patients. In 2020, Choksi et al conducted a survey of members of the American Academy of Family Practice, the Endocrine Society, and the American Geriatrics Society to get a better understanding of osteoporosis screening practices in real-world scenarios.3

Overall, 78.9% of endocrinologists, 53.1% of geriatricians, and 33.6% of primary care physicians reported reading at least 1 osteoporosis screening guideline. While nearly all respondents (90%) said they would always or frequently screen a 65-year-old postmenopausal woman for osteoporosis, only 22% said they would screen a 74-year-old man with no significant medical history. A total of 58% said that they would screen a 55-year-old man with a history of thyroid cancer on suppressive doses of thyroid hormone.3

Despite advances in both screening modalities and treatments, at-risk men are often not screened for fracture probability, nor are they educated about fracture prevention. Authors of a consensus statement from the Bone Health and Osteoporosis Foundation (BHOF) noted that while hip fractures significantly increase the risk for death within 1 year and are highly predictive of future fractures, between 80% to 95% of patients in some settings are discharged with no anti-fracture treatment or management plan following hip fracture repair.4

Even in cases where physicians want to perform BMD testing, there may not be enough machines to go around. In 2006, cuts to the Medicare Part B reimbursement for the provision of DXA testing brought payments down from $139.46 to a planned $55.00 in 2010 — well below the break-even point of $134.00.5

"The federal government has bean counters who said that it was too much money to pay for this procedure," Dr Morris explained. "As a result, there are fewer machines and there are fewer people doing the screening."

At the time of the cuts, approximately two-thirds of DXA scans were performed on machines in community offices, meaning that patients in rural areas and in areas without sufficient access to hospitals had more difficulty accessing the scans.5

Dr Morris added that his practice has the ability to do BMD testing. While the profit per procedure is negligible, he believes it's important to keep the machine to do what's right for the patient.

"I see too many patients who don't get bone densitometry," he said. "We can order it, but the convenience of having a machine is important. If the patient has to go to the hospital, park their car, walk around inside the hospital, and sit for a half hour before the procedure, then that's a burden."

Work to be Done

The osteoporosis treatment gap has been recognized by the BHOF as a global crisis in patient care.4 To alleviate this crisis, many approaches are required, such as cultivating trust among at-risk patients and engaging physicians and public health organizations.

While many physicians are well-versed in the risk factors for osteopenia and osteoporosis among women, there is a need to increase screening among older men, as well as younger men with significant risk factors such as low body weight, a history of smoking, or use of medications that can contribute to bone loss. This need is especially prominent in the primary care setting. 

Once a patient is diagnosed with osteoporosis or has been identified as having risk factors, the treatments at a physician's disposal are manifold and effective. Between medicines and lifestyle adjustments, most patients have several good options. If they're not screened, however, then fracture-related outcomes will continue to worsen.

"I also think the government needs to recognize that spending $30,000 on hip surgery is a lot more expensive than spending a reasonable amount of money for a bone density test," Dr Morris said. "If they were to double the amount of the payment for the test, then practice groups would be able to afford a bone density unit, and they would be able to more readily perform scans on women and men."

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