, Volume 23, Issue 11, pp 1815-1821

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.

Preliminary reports of this study were presented at the American College of Rheumatology Annual Scientific Meeting, Boston, MA, November 8, 2007, at the 7th International Symposium on Osteoporosis, National Osteoporosis Foundation, Washington DC, April 21, 2007 and at the HMO Research Network meeting, Portland, OR, March 19, 2007.