The importance of physicians' risk perception in osteoporosis treatment decision making

Recent physicians' guidelines for postmenopausal osteoporosis emphasize the use of fracture-risk scores. To determine whether adherence to the guidelines has potential to improve targeting of care, we examined survey results from a random sample of US primary care physicians prior to the new guidelines. Survey measures included physicians' knowledge, attitudes, and perceived barriers to care. Physicians' estimates of 5-yr and lifetime absolute hip fracture risks and their treatment decisions were examined for patient vignettes depicting postmenopausal women of varying ages, weights, and bone mineral density (BMD) results. The 360 US physician respondents were accurate in their estimates of lifetime fracture risk for all 4 vignettes, but overestimated 5-yr hip fracture risk by a factor of 10 or more; 36-45% of the physicians recommended treatment for patients whose history and BMD placed them below guideline-recommended treatment thresholds, and 5-yr risk estimates were strongly associated with prescription treatment decisions for 2 of 3 such vignettes (both p<0.01). Other potential barriers to care include medication costs and adverse effects. Our findings suggest efforts to improve targeting of osteoporosis care are appropriately addressing physicians' risk estimation. Evidence from other conditions suggests these efforts must be intensive and available at the point of care.