Archives of Osteoporosis

, Volume 7, Issue 1–2, pp 107–114 | Cite as

General medical practitioners' knowledge and beliefs about osteoporosis and its investigation and management

  • Renée OtmarEmail author
  • Susanne D. Reventlow
  • Geoffrey C. Nicholson
  • Mark A. Kotowicz
  • Julie A. Pasco
Original Article



This qualitative study explored beliefs and attitudes regarding osteoporosis and its management. General medical practitioners (GPs) were ambivalent about osteoporosis due to concern about financial barriers for patients and their own beliefs about the salience of osteoporosis. GPs considered investigation and treatment in the context of patients' whole lives.


We aimed to investigate barriers, enablers, and other factors influencing the investigation and management of osteoporosis using a qualitative approach. This paper analyses data from discussions with general medical practitioners (GPs) about their beliefs and attitudes regarding osteoporosis and its management.


Fourteen GPs and two practice nurses aged 27–89 years participated in four focus groups, from June 2010 to March 2011. Each group comprised 3–5 participants, and discussions were semi-structured, according to the protocol developed for the main study. Discussion points ranged from the circumstances under which GPs would initiate investigation for osteoporosis and their subsequent actions to their views about treatment efficacy and patient adherence to prescribed treatment. Audio recordings were transcribed and coded for analysis using analytic comparison to identify the major themes.


The GPs were not particularly concerned about osteoporosis in their patients or the general population, ranking diabetes, osteoarthritis, cardiovascular disease, and hypertension higher than concern about osteoporosis. They expressed confidence in the efficacy of anti-fracture medications but were concerned about the potential financial burden on patients with limited incomes. The GPs were unsure about guidelines for investigation and management of osteoporosis in men and the appropriate duration of treatment, particularly for the bisphosphonates in all patients.


The GPs' ambivalence about osteoporosis appeared to stem from structural factors such as financial barriers for patients and their own beliefs about the salience of osteoporosis. GPs considered the impact of investigating and prescribing treatment in the context of patients' whole lives.


Osteoporosis Qualitative methods General medical practitioners 


Conflicts of interest



  1. 1.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRefGoogle Scholar
  2. 2.
    Alonso-Coello P, Lopez A, Pencille LJ (2009) Is too much intervention recommended in the ACP osteoporosis treatment guidelines? Letter to the editor. Ann Intern Med 150:285–286Google Scholar
  3. 3.
    Lock CA, Lecouturier J, Mason JM, Dickinson HO (2005) Lifestyle interventions to prevent osteoporotic fractures: a systematic review. Osteoporos Int 17:20–28PubMedCrossRefGoogle Scholar
  4. 4.
    Sanders KM, Nicholson GC, Watts JJ, Pasco JA, Henry MJ, Kotowicz MA, Seeman E (2006) Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective? Bone 38:694–700PubMedCrossRefGoogle Scholar
  5. 5.
    Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD (2007) Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 24:37–55PubMedCrossRefGoogle Scholar
  6. 6.
    Chiang A, Jones J, Humphreys J, Martin C (2006) Osteoporosis: diagnosis and treatment in a general practice population. Aust Fam Physician 35:166–168PubMedGoogle Scholar
  7. 7.
    Inderjeeth CA, Glennon D, Petta A (2006) Study of osteoporosis awareness, investigation and treatment of patients discharged from a tertiary public teaching hospital. Intern Med J 36:547–551PubMedCrossRefGoogle Scholar
  8. 8.
    Richardson JC, Hassell AB, Thomas E, Hay EM (2004) GPs' perceptions of the role of DEXA scanning: an exploratory study. Fam Pract 21:51–53PubMedCrossRefGoogle Scholar
  9. 9.
    Rizzoli R, Brandi ML, Dreinhofer K, Thomas T, Wahl DA, Cooper C (2010) The gaps between patient and physician understanding of the emotional and physical impact of osteoporosis. Arch Osteoporos 5:145–153CrossRefGoogle Scholar
  10. 10.
    Reventlow S, Bang H (2006) Brittle bones: ageing or threat of disease—exploring women's cultural models of osteoporosis. Scand J Public Health 34:320–326PubMedCrossRefGoogle Scholar
  11. 11.
    Reventlow S, Overgaard I, Hvas L, Malterud K (2008) Metaphorical mediation in women's perceptions of risk related to osteoporosis: a qualitative interview study. Health Risk Soc 10:103–115CrossRefGoogle Scholar
  12. 12.
    Skolbekken J-A, Østerlie W, Forsmo S (2008) Brittle bones, pain and fractures—lay constructions of osteoporosis among Norwegian women attending the Nord-Trøndelag Health Study (HUNT). Soc Sci Med 66:2562–2572PubMedCrossRefGoogle Scholar
  13. 13.
    Kanis J, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6:1–146PubMedGoogle Scholar
  14. 14.
    Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F, Rizzoli R (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428PubMedCrossRefGoogle Scholar
  15. 15.
    Werner P (2005) Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int 16:115–127PubMedCrossRefGoogle Scholar
  16. 16.
    Edwards L, Fraser M (1997) How do we increase awareness of osteoporosis? Balliere Clin Rheumatol 11:631–644CrossRefGoogle Scholar
  17. 17.
    Werner P, Vered I (2002) The diagnosis of osteoporosis: attitudes and knowledge of Israeli physicians. Aging Clin Exp Res 14:52–59PubMedGoogle Scholar
  18. 18.
    Australian Bureau of Statistics (2007) Census of Population and Housing 2006. Commonwealth of Australia, CanberraGoogle Scholar
  19. 19.
    Kitzinger J (2006) Focus groups. In: Pope C, Mays N (eds) Qualitative research in health care, 3rd edn. Blackwell Publishing, Oxford, UKGoogle Scholar
  20. 20.
    Bradley EH, Curry LA, Devers KJ (2007) Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 42:1758–1772PubMedCrossRefGoogle Scholar
  21. 21.
    World Medical Association (2008) World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. In, 59th General Assembly, Seoul, Korea edn.Google Scholar
  22. 22.
    Neuman WL (2003) Social research methods: qualitative and quantitative methods. Allyn and Bacon, Boston, USAGoogle Scholar
  23. 23.
    Glaser BG, Strauss AL (1967) The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago, USAGoogle Scholar
  24. 24.
    Boeije H (2002) A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 26:391–409CrossRefGoogle Scholar
  25. 25.
    Silverman D, Marvasti A (2008) Doing qualitative research: a comprehensive guide. Sage Publications, Thousand Oaks, CAGoogle Scholar
  26. 26.
    O'Neill S, MacLennan A, Bass S et al (2004) Clinical practice: guidelines for the management of postmenopausal osteoporosis for GPs. Aust Fam Physician 33:910–917PubMedGoogle Scholar
  27. 27.
    Sturtridge W, Lentle B, Hanley DA (1996) Prevention and management of osteoporosis: Consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 2. The use of bone density measurement in the diagnosis and management of osteoporosis. Can Med Assoc J 155:924–929Google Scholar
  28. 28.
    Henry MJ, Pasco JA, Nicholson GC, Pocock NA, Kotowicz MA (2004) Reference ranges for bone densitometers adopted Australia-wide: Geelong Osteoporosis Study. Australas Radiol 48:473–475PubMedCrossRefGoogle Scholar
  29. 29.
    Henry MJ, Pasco JA, Korn S, Gibson JE, Kotowicz MA, Nicholson GC (2010) Bone mineral density reference ranges for Australian men: Geelong Osteoporosis Study. Osteoporos Int 21:909–917PubMedCrossRefGoogle Scholar
  30. 30.
    The Royal Australian College of General Practitioners R (2010) Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. In. RACGP, South Melbourne, Vic., AustraliaGoogle Scholar
  31. 31.
    Skolbekken JA (1995) The risk epidemic in medical journals. Soc Sci Med 40:291–305PubMedCrossRefGoogle Scholar
  32. 32.
    Antonacci MD, Hanson DS, Heggeness MH (1996) Pitfalls in the measurement of bone mineral density by dual energy X-ray absorptiometry. Spine 21:87–91PubMedCrossRefGoogle Scholar
  33. 33.
    Walker-Bone K, Reid D, Cooper C (1998) Is screening for osteoporosis worthwhile? Br Med Bull 54:915–927PubMedCrossRefGoogle Scholar
  34. 34.
    Hruschka DJ, Hadley C (2008) A glossary of culture in epidemiology. J Epidemiol Community Health 62:947–951PubMedCrossRefGoogle Scholar
  35. 35.
    Gourlay M (2009) Osteoporosis screening: mixed messages in primary care. Am Fam Physician 79:189–190PubMedGoogle Scholar
  36. 36.
    Hiligsmann M, Gathon HJ, Bruyère O, Ethgen O, Rabenda V, Reginster JY (2010) Cost-effectiveness of osteoporosis screening followed by treatment: the impact of medication adherence. Value in Health: The Journal of The International Society For Pharmacoeconomics And Outcomes Research 13:394–401CrossRefGoogle Scholar
  37. 37.
    Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui L-Y, Ransohoff DF, Cauley JA, Ensrud KE (2012) Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 366:225–233PubMedCrossRefGoogle Scholar
  38. 38.
    Petursson H, Getz L, Sigurdsson JA, Heltlevik I (2009) Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population. BMC Family Practice 10:Google Scholar
  39. 39.
    Sambrook PN, Chen JS, Simpson JM, March LM (2010) Impact of adverse news media on prescriptions for osteoporosis: effect on fractures and mortality. Med J Aust 193:154–156PubMedGoogle Scholar
  40. 40.
    Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR (2008) Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. Br Med J 336:262–266CrossRefGoogle Scholar
  41. 41.
    Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC (2010) Annual high-dose oral vitamin D for falls and fractures in elderly women: a randomised controlled trial. J Am Med Assoc 303:1815–1822CrossRefGoogle Scholar
  42. 42.
    Reginster J-Y (2011) Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs 71:65–78PubMedCrossRefGoogle Scholar
  43. 43.
    Schwarz P, Jorgensen NR, Mosekilde L, Vestergaard P (2011) The evidence for efficacy of osteoporosis treatment in men with primary osteoporosis: a systematic review and meta-analysis of antiresorptive and anabolic treatment in men. J Osteoporos 2011:259818PubMedGoogle Scholar
  44. 44.
    Ringe JD, Doherty JG (2010) Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat. Rheumatol Int 30:863–869PubMedCrossRefGoogle Scholar
  45. 45.
    Åstrand J, Thorngren K-G, Tägil M, Åkesson K (2008) 3-year follow-up of 215 fracture patients from a prospective and consecutive osteoporosis screening program. Fracture patients care! Acta Orthop 79:404–409PubMedCrossRefGoogle Scholar
  46. 46.
    Nielen MM, Assendelft WJ, Drenthen AJM, van den Hombergh P, van Dis I, Schellevis FG (2010) Primary prevention of cardio-metabolic diseases in general practice: a Dutch survey of attitudes and working methods of general practitioners. Eur J Gen Pract 16:139–142PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • Renée Otmar
    • 1
    • 2
    • 5
    Email author
  • Susanne D. Reventlow
    • 3
  • Geoffrey C. Nicholson
    • 4
  • Mark A. Kotowicz
    • 1
    • 2
  • Julie A. Pasco
    • 1
    • 2
  1. 1.School of MedicineDeakin UniversityGeelongAustralia
  2. 2.Department of Medicine, Northwest Academic CentreThe University of Melbourne, Sunshine HospitalSt AlbansAustralia
  3. 3.The Research Unit for General Practice and Section of General Practice, Department of Public HealthCopenhagen UniversityCopenhagen KDenmark
  4. 4.Rural Clinical School, School of MedicineThe University of QueenslandToowoombaAustralia
  5. 5.Barwon Epidemiology and Biostatistics Unit, School of MedicineDeakin UniversityGeelongAustralia

Personalised recommendations