Clinical and demographic factors determining patient fracture risk decision point (FRDP): The improving risk communication in osteoporosis (RICO) project.
FRAX® probability; Fracture Risk Decision Point (FRDP); Osteoporosis; Patient willingness to accept treatment; Treatment threshold; Endocrinology, Diabetes and Metabolism
Abstract :
[en] [en] UNLABELLED: This study aims to understand how osteoporosis medication acceptance varies across countries with differing guidance on treatment threshold and influence of clinical and demographic factors. A total of 79.2% accepted treatment at a fracture probability at or below the treatment threshold. Fracture history and age did not strongly impact acceptance, suggesting a need for improved fracture risk communication.
PURPOSE: This part of the Improving Risk Communication in Osteoporosis (RICO) study aims to understand patients' willingness to initiate osteoporosis treatment given a hypothetical fracture probability-derived from the FRAX® Risk Assessment Tool-and how age, fracture history, and numeric literacy may influence this.
METHODS: In 2022-2023, 332 postmenopausal women at risk of fracture were interviewed from nine countries to determine participants' Fracture Risk Decision Point (FRDP), the lowest probability of major osteoporotic fracture at which they would accept an osteoporosis medication. Participants' FRDP was evaluated given eight hypothetical 10-year FRAX scores.
RESULTS: In countries with FRAX-based treatment thresholds, over half of the participants per country reported an FRDP that was below the threshold. Collectively, 79.2% demonstrated FRDPs at or below their respective threshold. Age and fracture history did not have a strong influence on FRDP; however, those who demonstrated higher levels of numeric literacy reported a significantly higher median FRDP (10%) compared to those who showed lower levels (5%, p < 0.001).
CONCLUSIONS: Most patients were willing to accept an osteoporosis medication prescription at a hypothetical FRAX probability that was even lower than that of their nationally recommended treatment threshold. Literacy scores had a significant influence on FRDP whereas age and fracture history did not.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Sharma, Mitali ; The OMC Research Center, Beverly Hills, CA, USA. mxs2067@case.edu
Beaudart, Charlotte ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie générale ; Department of Health Services Research, CAPHRI Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
Clark, Patricia; Clinical Epidemiology Unit, Faculty of Medicine UNAM, Children's Hospital of Mexico Federico Gomez, Mexico City, Mexico
Fujiwara, Saeko; Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
Adachi, Jonathan D; McMaster University, Hamilton, ON, Canada
Papaioannou, Alexandra; McMaster University, Hamilton, ON, Canada
Messina, Osvaldo D; Investigaciones Reumatológicas y Osteológicas (IRO). Collaborating Centre WHO, Buenos Aires, Argentina ; IRO Medical Center, Investigaciones Reumatologicas y Osteologicas SRL, Buenos Aires, Argentina
Morin, Suzanne N; Department of Medicine, McGill University, Montreal, Canada
Kohlmeier, Lynn; Spokane Osteoporosis and Endocrinology, Spokane, WA, USA
Nogues, Xavier; Internal Medicine Department, CIBERFES (ISCIII), Hospital del Mar Research Institute, Pompeu Fabra University, Barcelona, Spain
Leckie, Carolyn; McMaster University, Hamilton, ON, Canada
Harvey, Nicholas C; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK ; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, UK
Kanis, John A; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ; Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique ; Protein Research Chair, Biochemistry Dept, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
Hiligsmann, Mickaël ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé ; Department of Health Services Research, CAPHRI Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
Silverman, Stuart L; The OMC Research Center, Beverly Hills, CA, USA ; Cedars-Sinai Medical Center, Los Angeles, CA, USA
Clinical and demographic factors determining patient fracture risk decision point (FRDP): The improving risk communication in osteoporosis (RICO) project.
Publication date :
21 October 2024
Journal title :
Osteoporosis International
ISSN :
0937-941X
eISSN :
1433-2965
Publisher :
Springer Science and Business Media Deutschland GmbH, England
Open access funding provided by SCELC, Statewide California Electronic Library Consortium. The RICO (Risk Communication in Osteoporosis) project has received funding from Amgen US/UCB. Amgen did not display any financial or proprietary interest that could impact the analysis and interpretation of results.
S.L. Silverman A.D. Calderon The utility and limitations of FRAX: a US perspective Curr Osteoporos Rep 2010 8 4 192 197 10.1007/s11914-010-0032-1 20811963 2947011
J.A. Kanis N.C. Harvey C. Cooper H. Johansson A. Odén E.V. McCloskey A systematic review of intervention thresholds based on FRAX: a report prepared for the national osteoporosis guideline group and the international osteoporosis foundation Arch Osteoporos 2016 11 1 25 10.1007/s11657-016-0278-z 27465509 4978487
P. Clark E. Denova-Gutiérrez C. Zerbini A. Sanchez O. Messina J.J. Jaller C. Campusano C.H. Orces G. Riera H. Johansson J.A. Kanis FRAX-based intervention and assessment thresholds in seven Latin American countries Osteoporos Int 2018 29 3 707 715 10.1007/s00198-017-4341-4 29273826 1:STN:280:DC%2BC1MzkslGjtQ%3D%3D
Litwic AE, Compston JE, Wyman A, Siris ES, Gehlbach SH, Adachi JD, Chapurlat R, Díez-Pérez A, LaCroix AZ, Nieves JW, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Saag KG, Silverman S, Watts NB, Greenspan SL, March L, Gregson CL, … Global Longitudinal Study of Osteoporosis in Women (GLOW) Investigators (2017) Self-perception of fracture risk: what can it tell us?. Osteoporosis Int 28(12):3495–3500. https://doi.org/10.1007/s00198-017-4200-3
Beaudart C, Sharma M, Clark P, Fujiwara S, Adachi JD, Messina OD, Morin SN, Kohlmeier LA, Sangan CB, Nogues X, Cruz-Priego GA, Cavallo A, Cooper F, Grier J, Leckie C, Montiel-Ojeda D, Papaioannou A, Raskin N, Yurquina L, … Hiligsmann M (2024) Patients’ preferences for fracture risk communication: the Risk Communication in Osteoporosis (Rico) study. Osteoporos Int 35(3):451–468. https://doi.org/10.1007/s00198-023-06955-9
C. Beaudart M. Hiligsmann N. Li E.M. Lewiecki S. Silverman Effective communication regarding risk of fracture for individuals at risk of fragility fracture: a scoping review Osteoporos Int 2022 33 13 26 10.1007/S00198-021-06151-7 34559256
M. Galesic R. Garcia-Retamero Graph literacy: a cross-cultural comparison Med Decis Making 2011 31 444 457 10.1177/0272989X10373805 20671213
M. Galesic R. Garcia-Retamero G. Gigerenzer Using icon arrays to communicate medical risks: overcoming low numeracy Health Psychol: Off J Div Health Psychol, Am Psychol Assoc 2009 28 2 210 216 10.1037/a0014474
A. Fagerlin B.J. Zikmund-Fisher P.A. Ubel et al. Measuring numeracy without a math test: development of the Subjective Numeracy Scale Med Decis Making 2007 27 672 680 10.1177/0272989X07304449 17641137
M. Lorentzon Treating osteoporosis to prevent fractures: current concepts and future developments J Intern Med 2019 285 4 381 394 10.1111/joim.12873 30657216
Gregson CL, Dennison EM, Compston JE, Adami S, Adachi JD, Anderson FA, Jr, Boonen S, Chapurlat R, Díez-Pérez A, Greenspan SL, Hooven FH, LaCroix AZ, Nieves JW, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Saag KG, Silverman S, Siris ES, … GLOW Investigators (2014) Disease-specific perception of fracture risk and incident fracture rates: GLOW cohort study. Osteoporos Int 25(1):85–95.https://doi.org/10.1007/s00198-013-2438-y
Copn – our patient network | Osteoporosis Canada. (2019, April 8). https://osteoporosis.ca/copn-patient-network/. Accessed 21 May 2023
J.A. Cauley Osteoporosis in men: prevalence and investigation Clin Cornerstone 2006 8 S20 S25 10.1016/S1098-3597(06)80020-7 17046426
Section 4: Intervention thresholds and strategy. (n.d.). Retrieved March 20, 2024, from https://www.nogg.org.uk/full-guideline/section-4-intervention-thresholds-and-strategy. Accessed 20 Mar 2024
How we help | ROS. (n.d.). Retrieved May 21, 2023, from https://theros.org.uk/what-we-do/how-we-help/. Accessed 21 May 2023
