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Patient Decision to Initiate Therapy for Osteoporosis: The Influence of Knowledge and Beliefs

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Abstract

Background

There are effective treatments to prevent osteoporotic fractures, but these treatments are underutilized.

Objective

To evaluate the influence of patient characteristics, perceptions, knowledge and beliefs about osteoporosis on the decision to initiate osteoporotic treatment.

Participants

We identified female members of a managed care plan who had a dual energy x-ray absorptiometry (DXA) bone density test and fulfilled World Health Organization criteria for osteoporosis. Patients were excluded if they received osteoporotic medications in the prior 6 months.

Measurements

Patients were sent a questionnaire that included items assessing satisfaction with physician–patient communication, trust in the physician, osteoporosis knowledge and beliefs, beliefs about prescription medications, and perceptions of barriers to medication use. Administrative electronic health records were used to identify prescription drug use and health care utilization.

Results

Two hundred and thirty-six women returned surveys and research authorization forms out of 465 contacted for participation. One hundred and thirty-five (57.2%) filled a prescription for an osteoporotic drug in the first 3 months after the DXA exam. The largest differences between initiators and non-initiators were in beliefs in the benefits of medications, and distrust of medications, with initiators believing more strongly in the benefits and effectiveness of medications (p < .001), and non-initiators reporting more distrust of medications (p < .001). Osteoporosis knowledge and the belief that osteoporosis is a serious disease were also related to therapy initiation in bivariate analysis.

Conclusions

Only 57% of patients initiated osteoporotic medication within 3 months of diagnosis. The decision to start osteoporosis treatment appeared to be related to a patient’s beliefs in the effectiveness of osteoporosis medications and distrust of medications.

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Acknowledgment

The authors thank Brooke Harrow PhD for helpful review of the manuscript.

Conflicts of interest

This study was funded by a grant from Novartis Pharmaceuticals Corporation. Robert Yood has received financial support from Merck for pharmaceutical drug trials, from Novartis for a research study, and from Procter and Gamble for consultancy. Merck, Novartis, and Procter and Gamble are makers of drugs for the treatment of osteoporosis. Kathleen Mazor has no potential conflicts of interest to report. Susan Andrade has received financial support (through grants and consultancies) from Merck and Novartis. Srinivas Emani has no potential conflicts of interest to report. Wing Chan and Kristijan Kahler are employees of Novartis.

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Authors and Affiliations

  1. Fallon Clinic, Worcester, MA, USA

    Robert A. Yood MD & Srinivas Emani PhD

  2. Meyers Primary Care Institute, Worcester, MA, USA

    Robert A. Yood MD, Kathleen M. Mazor EdD & Susan E. Andrade ScD

  3. Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

    Wing Chan MS & Kristijan H. Kahler PhD

Authors
  1. Robert A. Yood MD
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  2. Kathleen M. Mazor EdD
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  3. Susan E. Andrade ScD
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  4. Srinivas Emani PhD
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  5. Wing Chan MS
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  6. Kristijan H. Kahler PhD
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Correspondence to Robert A. Yood MD.

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Yood, R.A., Mazor, K.M., Andrade, S.E. et al. Patient Decision to Initiate Therapy for Osteoporosis: The Influence of Knowledge and Beliefs. J GEN INTERN MED 23, 1815–1821 (2008). https://doi.org/10.1007/s11606-008-0772-0

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  • DOI: https://doi.org/10.1007/s11606-008-0772-0

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