AAOS Bulletin - April, 2005

Effective osteoporosis treatment: Understand fears

Survey shows disconnect between patient fears, physician approaches

Results of a recent national Women’s Bone Health Survey highlight the importance of doctors understanding their patients’ fears about osteoporosis and how those fears can motivate patients to take their medication.


The majority of women with osteoporosis who participated in the survey (57 percent) said that the desire to remain healthy and independent is what motivates them to take an osteoporosis medication. Yet most doctors (74 percent) believe the fear of breaking or fracturing a bone is what motivates their patients to treat their osteoporosis.

The survey of 752 postmenopausal women diagnosed with osteoporosis and 352 physicians was conducted by the Opinion Research Corporation in collaboration with the nonprofit Alliance for Aging Research. Support and assistance was provided by GlaxoSmithKline and Roche, which produce medications to treat osteoporosis.

Treatment noncompliance

A key part of protecting bones in patients with osteoporosis is taking medication, yet 70 percent of physicians think that poor persistence (patients not staying on treatment for as long as needed) is a problem in their practice.

A recent study of prescription data on women with postmenopausal osteoporosis conducted by Roche showed that half to almost two thirds of patients discontinued their osteoporosis medication within one year. Studies have also shown that lack of persistence with osteoporosis medication can potentially result in an increased risk for fractures and increased health care costs.1,2

“In my experience,” says Mary I. O’Conner, MD, chair of the AAOS Women’s Health Issues Committee, “patients are highly variable in their compliance with osteoporosis medications, particularly bisphosphonates. The patients who are most compliant are those who are most educated about the importance of treatment and those who have personally had experience with a fragility fracture or recall a loved one having a disabling hip fracture.”

According to the Women’s Bone Health Survey, 67 percent of women who quit taking their bisphosphonate therapy (n=140) said they stopped because of side effects (primarily gastrointestinal discomfort). Although women are aware of osteoporosis (six out of ten were not surprised when they were diagnosed with osteoporosis), it is not necessarily a priority for them. Almost half (47 percent) of women who went off their osteoporosis medication said they quit because other diseases or conditions are more important to them than treating their osteoporosis.

When surveyed physicians were asked why patients did not stay on their bisphosphonate therapy, the top three barriers listed were side effects (87 percent), taking too many pills for other conditions (68 percent) and other health concerns taking priority over treating osteoporosis (56 percent). These physicians believed that lack of perceived benefits of treatment (43 percent) and inconvenient dosing regimens (20 percent) are barriers, as well. However, almost all physicians (97 percent) surveyed believed that staying on osteoporosis prescription therapy (persistence) will reduce fracture risk.

Improving persistence

“Women continue to put themselves at risk for fractures that can lead to pain, physical disability, loss of independence and even premature death by stopping osteoporosis treatment too soon,” says Sydney L. Bonnick, MD, medical director of the Clinical Research Center of North Texas in Denton, Texas.

In looking for ways to improve persistence, the 2004 Surgeon General’s Report on Bone Health and Osteoporosis recommended research to examine whether lower doses, shorter courses or wider spacing of treatment could help encourage women to stick with treatment and take their medications as directed—thus preventing fractures.

The majority of physicians surveyed agreed and noted that simplifying and organizing the osteoporosis treatment regimen (88 percent) and wider spacing of treatments (80 percent) would help improve persistence. Although weekly osteoporosis treatments have helped patients stay on therapy longer than daily dosing, persistence is still suboptimal.

Better communication

The Women’s Bone Health Survey also revealed that doctors and patients may not be speaking the same language, nor speaking often enough, about osteoporosis. More than half of doctors (56 percent) do not speak with their osteoporosis patients about the condition at each visit, and nearly two thirds of patients surveyed (62 percent) agree.

“It’s clear that better doctor-patient communication is needed since doctors aren’t tapping into the emotional catalysts that drive women to protect their bones, and by extension, their independence,” says Daniel Perry, executive director of the Alliance for Aging Research. “Physicians and patients need to be speaking a common language to encourage more patients to start and stay on their osteoporosis medication.”

To improve the communication process between patients and physicians, the Alliance has developed a free discussion guide for use by patients and physicians during office visits. The guide provides questions, tips and advice to facilitate better communication and understanding of osteoporosis risks, prevention and treatment. To sign up to receive the free guide, patients and physicians can go to www.agingresearch.org.

“This is all about education,” agrees Dr. O’Connor. “Everyone understands that elevated cholesterol is bad for your heart. What we do not have is an understanding that the lack of calcium and vitamin D is bad for your bones. Patients seem open to nutritional supplements, and if they are taking calcium and vitamin D, they already have some understanding of the importance of bone health.

“I try to find the extra minute to discuss supplements and explain peak bone mass,” says Dr. O’Connor. “That’s a concept that engages them…no one likes to hear that their bones are getting weaker.”

References

1. Caro JJ, Ishak K, Huybrechts K, Raggio G, Naujoks C. The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos. Int. 2004; (12):1003-1008.

2. McCombs JS, Thiebaud P, McLaughlin-Miley C, Shi J. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas. 2004;48(3):271-87


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