Patient perceptions of osteoporosis treatment thresholds. J Rheumatol 2014 Mar;41(3):516-22
Date
02/04/2014Pubmed ID
24488417Pubmed Central ID
PMC4060529DOI
10.3899/jrheum.130548Scopus ID
2-s2.0-84895490530 (requires institutional sign-in at Scopus site) 17 CitationsAbstract
OBJECTIVE: Many older patients express concerns about medication risks, and have higher risk thresholds than physicians for cardiovascular preventive medications. We hypothesized that patients have relatively high risk thresholds for fracture preventive medications.
METHODS: Women ≥ 60 years old were recruited from 3 primary care internal medicine clinics in Wisconsin. Participants were provided information regarding fracture risks and treatment risks and benefits, followed by a series of vignettes depicting a 70-year-old woman at baseline fracture risks between 5-50%. Fracture risks were shown graphically and treatment side effects were provided for each vignette, and participants were asked to respond regarding whether they would accept treatment. The association of vignette treatment acceptance with participant beliefs regarding medication risks was examined in analyses adjusted for perceived risk of medications, patient numeracy, and prior respondent experience with osteoporosis.
RESULTS: The mean age of women in the cohort was 69.4 years (SD 7.29). Ninety-one percent were non-Hispanic whites, 34% reported a history of fracture, and 20.3% a history of osteoporosis. Subjects varied substantially in their responses to vignettes, but only 51% reported they would accept prescription osteoporosis treatment at the threshold currently recommended by national physician treatment guidelines, and fewer would accept treatment at lower risks. Belief that medications are generally not worth their risks was associated with lower acceptance of treatment at all levels of fracture risk.
CONCLUSION: There is substantial variability in preferences for postmenopausal osteoporosis treatment. Presentation of individualized fracture risks as recommended by current guidelines has potential to allow better targeting to higher-risk patients, but further work is needed regarding how to present this information and counsel patients.
Author List
Neuner JM, Schapira MMAuthor
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Bone Density Conservation Agents
Female
Humans
Middle Aged
Osteoporosis
Patient Satisfaction
Perception
Practice Guidelines as Topic