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Understanding fragility fracture patients' decision-making process regarding bisphosphonate treatment
L A Wozniak1,2, J A Johnson1, F A McAlister1,2
1School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, T6G 2E1, Edmonton, Alberta, Canada.
Older adults often stop osteoporosis treatment due to perceived low severity and optionality. Reinforcing treatment benefits and risks of untreated osteoporosis can improve persistence with osteoporosis management.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Health Psychology
Background:
- Osteoporosis (OP) significantly increases recurrent fracture risk in older adults, with treatment reducing this risk by 50%.
- Despite high risk, only 20% of fracture patients receive OP treatment, and half discontinue within one year.
Purpose of the Study:
- To explore decision-making processes of older patients (50+ years) regarding persistence with or cessation of osteoporosis treatment over one year post-fracture.
- To understand factors influencing treatment adherence in elderly individuals managing osteoporosis.
Main Methods:
- Grounded theory study involving 21 interviews with 12 patients aged 50+ who experienced upper extremity fractures and initiated bisphosphonate therapy.
- Theoretical sampling and constant comparison analysis were employed until data saturation.
Main Results:
- Patients often perceived osteoporosis as not serious, with negligible impact.
- Treatment persistence correlated with perceiving greater benefits and fewer risks, viewing treatment as 'required' versus 'optional'.
- Treatment status could change post-fracture as patients re-evaluated OP's severity against treatment risks and benefits.
Conclusions:
- Decision-making regarding osteoporosis treatment is complex and dynamic, influenced by evolving perceptions of disease severity and treatment efficacy.
- Healthcare providers should emphasize the risks of untreated osteoporosis and the favorable benefit-risk profile of available treatments to enhance patient adherence.
- Interventions targeting patient education on osteoporosis severity and treatment value are crucial for improving long-term management.
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