Advertisement

Osteoporosis prevention: where are the barriers to improvement in a French general population? A qualitative study

  • B. Merle
  • C. Dupraz
  • J. Haesebaert
  • L. Barraud
  • M. Aussedat
  • C. Motteau
  • V. Simon
  • A.M. Schott
  • M. Flori
Original Article
  • 72 Downloads

Abstract

Summary

We conducted a qualitative study with French men and women in order to provide insight into individuals’ experiences, behaviors, and perceptions about osteoporosis (OP) and OP care. The data showed that both sexes, but especially men, were unfamiliar with OP, did not always feel concerned, and mistrusted pharmacological treatments.

Introduction

To engage actively in osteoporosis (OP) prevention, people need to have basic knowledge about the disease. The aim of this qualitative study was to explore knowledge and representations of OP care and prevention among both men and women.

Methods

Focus groups were conducted in the Rhône-Alpes Region, France, with women aged 50–85 years and men aged 60–85 years, with or without a history of fragility fracture and/or an OP diagnosis (respectively referred to as “aware” or “unaware”). A total of 45 women (23 “aware” and 22 “unaware” in 5 and 4 focus groups, respectively) and 53 men (19 “aware” and 34 “unaware” in 3 and 4 focus groups, respectively) were included. A thematic analysis of transcripts was performed to explore knowledge and representations about OP, risk factors, prevention, and treatment.

Results

The data showed that both sexes, but especially men, had limited knowledge of OP and considered it as a natural aging process not related to fragility fractures. They generally did not feel concerned by OP and no important difference was observed between “aware” and “unaware” patients. Women expressed their fear of the disease, associated with aging and the end of life, while men considered it to be a women’s disease only. Both sexes were aware of OP risk factors, but were suspicious towards treatments because of the associated side effects.

Conclusion

Understanding people’s representation of OP might help to provide patients with relevant information in order to optimize their preventive behavior and decrease the burden of the disease.

Keywords

Focus groups France Men osteoporosis Osteoporosis management Qualitative research Women osteoporosis 

Notes

Acknowledgements

The authors thank APICIL for having given access to their members and the women and men who took part in the study and accepted to share their ideas and experiences.

Compliance with ethical standards

The study was approved by the local ethics committee (Institutional Review Board: IORG0007394. Ref: IRBN092014/CHUSTE).

Conflict of interest

None.

References

  1. 1.
    Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Strom O, Borgstrom F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jonsson B (2011) Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the international Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6:59–155CrossRefPubMedCentralGoogle Scholar
  3. 3.
    Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA, EURPo IOF (2013) Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8:137CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Maravic M, Taupin P, Landais P, Roux C (2011) Change in hip fracture incidence over the last 6 years in France. Osteoporos Int 22:797–801CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Briot K, Cortet B, Thomas T et al (2012) 2012 update of French guidelines for the pharmacological treatment of postmenopausal osteoporosis. Joint Bone Spine 79:304–313CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY, Scientific Advisory Board of the European Society for C, Economic Aspects of O, Osteoarthritis, the Committee of Scientific Advisors of the International Osteoporosis F (2013) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24:23–57CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24:393–406CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Mitchell PJ (2013) Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep 11:52–60CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Nayak S, Greenspan SL (2018) How can we improve osteoporosis care? A systematic review and meta-analysis of the efficacy of quality improvement strategies for osteoporosis. J Bone Miner Res 33:1585–1594CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporos Int 23:1623–1629CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Cheng N, Green ME (2008) Osteoporosis screening for men: are family physicians following the guidelines? Can Fam Physician 54:1140–1141 1141 e1141–1145PubMedPubMedCentralGoogle Scholar
  14. 14.
    Giangregorio L, Papaioannou A, Thabane L, DeBeer J, Cranney A, Dolovich L, Adili A, Adachi JD (2008) Do patients perceive a link between a fragility fracture and osteoporosis? BMC Musculoskelet Disord 9:38CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Sale JE, Beaton DE, Sujic R, Bogoch ER (2010) ‘If it was osteoporosis, I would have really hurt myself.’ Ambiguity about osteoporosis and osteoporosis care despite a screening programme to educate fragility fracture patients. J Eval Clin Pract 16:590–596PubMedPubMedCentralGoogle Scholar
  16. 16.
    Malochet-Guinamand S, Chalard N, Billault C, Breuil N, Ristori JM, Schmidt J (2005) Osteoporosis treatment in postmenopausal women after peripheral fractures: impact of information to general practitioners. Joint Bone Spine 72:562–566CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Alami S, Hervouet L, Poiraudeau S, Briot K, Roux C (2016) Barriers to effective postmenopausal osteoporosis treatment: a qualitative study of patients’ and practitioners’ views. PLoS One 11:e0158365CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Weston JM, Norris EV, Clark EM (2011) The invisible disease: making sense of an osteoporosis diagnosis in older age. Qual Health Res 21:1692–1704CrossRefPubMedCentralGoogle Scholar
  19. 19.
    Kitzinger J (1995) Qualitative research. Introducing focus groups. BMJ 311:299–302CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Merle B, Chapurlat R, Vignot E, Thomas T, Haesebaert J, Schott AM (2017) Post-fracture care: do we need to educate patients rather than doctors? The PREVOST randomized controlled trial. Osteoporos Int 28:1549–1558CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Chaitou A, Boutroy S, Vilayphiou N, Munoz F, Delmas PD, Chapurlat R, Szulc P (2010) Association between bone turnover rate and bone microarchitecture in men: the STRAMBO study. J Bone Miner Res 25:2313–2323CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Lau E, Papaioannou A, Dolovich L, Adachi J, Sawka AM, Burns S, Nair K, Pathak A (2008) Patients’ adherence to osteoporosis therapy: exploring the perceptions of postmenopausal women. Can Fam Physician 54:394–402PubMedPubMedCentralGoogle Scholar
  23. 23.
    Barker KL, Toye F, Lowe CJ (2016) A qualitative systematic review of patients’ experience of osteoporosis using meta-ethnography. Arch Osteoporos 11:33CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Baheiraei A, Ritchie JE, Eisman JA, Nguyen TV (2006) Exploring factors influencing osteoporosis prevention and control: a qualitative study of Iranian men and women in Australia. Maturitas 54:127–134CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Besser SJ, Anderson JE, Weinman J (2012) How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice. Arch Osteoporos 7:115–124CrossRefPubMedCentralGoogle Scholar
  26. 26.
    Sale JE, Gignac MA, Frankel L, Hawker G, Beaton D, Elliot-Gibson V, Bogoch E (2012) Patients reject the concept of fragility fracture--a new understanding based on fracture patients communication. Osteoporos Int 23:2829–2834CrossRefPubMedCentralGoogle Scholar
  27. 27.
    Gaines JM, Marx KA (2011) Older men’s knowledge about osteoporosis and educational interventions to increase osteoporosis knowledge in older men: a systematic review. Maturitas 68:5–12CrossRefPubMedCentralGoogle Scholar
  28. 28.
    Solimeo SL (2011) Living with a ‘women’s disease’: risk appraisal and management among men with osteoporosis. J Mens Health 8:185–191CrossRefPubMedCentralGoogle Scholar
  29. 29.
    Solimeo SL, Weber TJ, Gold DT (2011) Older men’s explanatory model for osteoporosis. Gerontologist 51:530–539CrossRefPubMedCentralGoogle Scholar
  30. 30.
    Banu J (2013) Causes, consequences, and treatment of osteoporosis in men. Drug Des Devel Ther 7:849–860CrossRefPubMedCentralGoogle Scholar
  31. 31.
    Leventhal H, Benyamini Y, Brownlee S, Diefenbach M, Leventhal EA, Patrick-Miller L, Robitaille C (1997) Illness representations: theoretical foundations. In: Petrie KJ, Weinman JA (eds) Perceptions of health and illness. Harwood Academic, Amsterdam, pp 19–45Google Scholar
  32. 32.
    Reventlow SD, Hvas L, Malterud K (2006) Making the invisible body visible. Bone scans, osteoporosis and women’s bodily experiences. Soc Sci Med 62:2720–2731CrossRefPubMedCentralGoogle Scholar
  33. 33.
    Reventlow SD (2007) Perceived risk of osteoporosis: restricted physical activities? Qualitative interview study with women in their sixties. Scand J Prim Health Care 25:160–165CrossRefPubMedCentralGoogle Scholar
  34. 34.
    Fogelman Y, Goldshtein I, Segal E, Ish-Shalom S (2016) Managing osteoporosis: a survey of knowledge, attitudes and practices among primary care physicians in Israel. PLoS One 11:e0160661CrossRefPubMedCentralGoogle Scholar
  35. 35.
    Iversen MD, Vora RR, Servi A, Solomon DH (2011) Factors affecting adherence to osteoporosis medications: a focus group approach examining viewpoints of patients and providers. J Geriatr Phys Ther 34:72–81CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Yu J, Brenneman SK, Sazonov V, Modi A (2015) Reasons for not initiating osteoporosis therapy among a managed care population. Patient Prefer Adherence 9:821–830PubMedPubMedCentralGoogle Scholar
  37. 37.
    Lindsay BR, Olufade T, Bauer J, Babrowicz J, Hahn R (2016) Patient-reported barriers to osteoporosis therapy. Arch Osteoporos 11:19CrossRefPubMedCentralGoogle Scholar
  38. 38.
    Crawford Shearer NB (2009) Health empowerment theory as a guide for practice. Geriatr Nurs 30:4–10CrossRefGoogle Scholar
  39. 39.
    Nielsen D, Huniche L, Brixen K, Sahota O, Masud T (2013) Handling knowledge on osteoporosis--a qualitative study. Scand J Caring Sci 27:516–524CrossRefPubMedCentralGoogle Scholar
  40. 40.
    Meadows LM, Mrkonjic L, Lagendyk L (2005) Women’s perceptions of future risk after low-energy fractures at midlife. Ann Fam Med 3:64–69CrossRefPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • B. Merle
    • 1
  • C. Dupraz
    • 2
  • J. Haesebaert
    • 3
  • L. Barraud
    • 2
  • M. Aussedat
    • 2
  • C. Motteau
    • 2
  • V. Simon
    • 2
  • A.M. Schott
    • 3
  • M. Flori
    • 2
    • 4
  1. 1.INSERM Research Unit 1033Université Lyon 1LyonFrance
  2. 2.Collège Universitaire Médecine GénéraleUniversité Lyon 1LyonFrance
  3. 3.Hospices Civils de Lyon, HESPER EA 7425Université Lyon 1LyonFrance
  4. 4.EA 4129-Parcours Santé SystémiqueUniversité Lyon 1LyonFrance

Personalised recommendations