Abstract
Background: Bisphosphonates (BPs) can reduce fracture risk for adults with osteoporosis (OP), but they have rare risks, complicating decision making. Guided by an established health decision and communication framework, we explored older women's feelings and positions toward taking BPs.Materials and Methods: Using a mixed-methods design, we interviewed women >65 years of age who had never taken BPs. After learning about BPs, participants responded to items about their feelings toward medication benefits/risks. They then identified their overall position toward taking BPs (corresponding to Unquestioning Acceptors, Cautious Acceptors, Hesitants, Probable Refusers, and Definite Refusers). We analyzed data using qualitative content analysis and summarized quantitative data with descriptive statistics.Results: Thirty women participated. Acceptors (N = 17, 56.6%) worried about OP-related fractures. Hesitant participants (N = 12, 40%) worried about BP risks, yet expressed openness toward medications if given opportunities to gather information and talk to clinicians. One Refuser expressed distrust in clinicians and pharmaceuticals.Conclusions: Understanding women's positions toward BPs might improve decision-making processes for OP treatment. Clinicians could tailor communication based on patients' identified BP position. Acceptors might be comfortable with succinct conversations describing medications. Hesitant patients might need more information from resources such as decision aids. Building trust with patients questioning BPs can support future conversations.
Highlights
Osteoporosis (OP) is characterized by decreased bone mass and porous bones
Participant characteristics Sixty-five women were screened for eligibility
The position framework described in this study improves our understanding of how treatment-naive women approach the decision of whether to initiate BPs for OP
Summary
Osteoporosis (OP) is characterized by decreased bone mass and porous bones. Individuals with OP experience a higher risk of fracture than those with normal bone density.[1,2] Over 12 million Americans will be diagnosed with OP by 2020,3 with women more frequently affected than men.[4,5] OP-related hip fractures, vertebral fractures, and kyphosis (spine curvature) are associated with difficulty performing activities of daily living, reduced quality of life, chronic pain, and mortality.[6,7] OP-related fractures in the United States may cost about 20 billion dollars annually.[8]BPs are the most commonly prescribed medications for OP. BPs prevent further bone loss and decrease fracture risk.[9,10] these medications can cause very rare, but serious, complications: atypical femur fracture,[11] occurring in about 5 cases per 10,000 patientyears,[12] and osteonecrosis of the jaw, occurring in Departments of 1Surgery and 4Occupational Therapy, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, USA. Guided by an established health decision and communication framework, we explored older women’s feelings and positions toward taking BPs. Materials and Methods: Using a mixed-methods design, we interviewed women >65 years of age who had never taken BPs. After learning about BPs, participants responded to items about their feelings toward medication benefits/risks. Hesitant participants (N = 12, 40%) worried about BP risks, yet expressed openness toward medications if given opportunities to gather information and talk to clinicians. Building trust with patients questioning BPs can support future conversations
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