Skip to main content
Log in

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

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141

    Article  CAS  Google Scholar 

  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 6:59–155

    Article  CAS  Google Scholar 

  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 8:136

    Article  CAS  Google Scholar 

  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 8:137

    Article  CAS  Google Scholar 

  5. Maravic M, Taupin P, Landais P, Roux C (2011) Change in hip fracture incidence over the last 6 years in France. Osteoporos Int 22:797–801

    Article  CAS  Google Scholar 

  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 79:304–313

    Article  Google Scholar 

  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 24:23–57

    Article  CAS  Google Scholar 

  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 24:393–406

    Article  CAS  Google Scholar 

  9. Mitchell PJ (2013) Best practices in secondary fracture prevention: fracture liaison services. Curr Osteoporos Rep 11:52–60

    Article  Google Scholar 

  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 33:1585–1594

    Article  Google Scholar 

  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 23:1623–1629

    Article  CAS  Google Scholar 

  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 35:293–305

    Article  CAS  Google Scholar 

  13. Cheng N, Green ME (2008) Osteoporosis screening for men: are family physicians following the guidelines? Can Fam Physician 54:1140–1141 1141 e1141–1145

    PubMed  PubMed Central  Google Scholar 

  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 9:38

    Article  Google Scholar 

  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 16:590–596

    PubMed  Google Scholar 

  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 72:562–566

    Article  Google Scholar 

  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:e0158365

    Article  Google Scholar 

  18. Weston JM, Norris EV, Clark EM (2011) The invisible disease: making sense of an osteoporosis diagnosis in older age. Qual Health Res 21:1692–1704

    Article  Google Scholar 

  19. Kitzinger J (1995) Qualitative research. Introducing focus groups. BMJ 311:299–302

    Article  CAS  Google Scholar 

  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 28:1549–1558

    Article  CAS  Google Scholar 

  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 25:2313–2323

    Article  Google Scholar 

  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 54:394–402

    PubMed  Google Scholar 

  23. Barker KL, Toye F, Lowe CJ (2016) A qualitative systematic review of patients’ experience of osteoporosis using meta-ethnography. Arch Osteoporos 11:33

    Article  CAS  Google Scholar 

  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 54:127–134

    Article  Google Scholar 

  25. Besser SJ, Anderson JE, Weinman J (2012) How do osteoporosis patients perceive their illness and treatment? Implications for clinical practice. Arch Osteoporos 7:115–124

    Article  Google Scholar 

  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 23:2829–2834

    Article  CAS  Google Scholar 

  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 68:5–12

    Article  Google Scholar 

  28. Solimeo SL (2011) Living with a ‘women’s disease’: risk appraisal and management among men with osteoporosis. J Mens Health 8:185–191

    Article  Google Scholar 

  29. Solimeo SL, Weber TJ, Gold DT (2011) Older men’s explanatory model for osteoporosis. Gerontologist 51:530–539

    Article  Google Scholar 

  30. Banu J (2013) Causes, consequences, and treatment of osteoporosis in men. Drug Des Devel Ther 7:849–860

    Article  CAS  Google Scholar 

  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 19–45

    Google Scholar 

  32. Reventlow SD, Hvas L, Malterud K (2006) Making the invisible body visible. Bone scans, osteoporosis and women’s bodily experiences. Soc Sci Med 62:2720–2731

    Article  Google Scholar 

  33. Reventlow SD (2007) Perceived risk of osteoporosis: restricted physical activities? Qualitative interview study with women in their sixties. Scand J Prim Health Care 25:160–165

    Article  Google Scholar 

  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:e0160661

    Article  Google Scholar 

  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 34:72–81

    Article  Google Scholar 

  36. Yu J, Brenneman SK, Sazonov V, Modi A (2015) Reasons for not initiating osteoporosis therapy among a managed care population. Patient Prefer Adherence 9:821–830

    PubMed  PubMed Central  Google Scholar 

  37. Lindsay BR, Olufade T, Bauer J, Babrowicz J, Hahn R (2016) Patient-reported barriers to osteoporosis therapy. Arch Osteoporos 11:19

    Article  Google Scholar 

  38. Crawford Shearer NB (2009) Health empowerment theory as a guide for practice. Geriatr Nurs 30:4–10

    Article  Google Scholar 

  39. Nielsen D, Huniche L, Brixen K, Sahota O, Masud T (2013) Handling knowledge on osteoporosis--a qualitative study. Scand J Caring Sci 27:516–524

    Article  Google Scholar 

  40. Meadows LM, Mrkonjic L, Lagendyk L (2005) Women’s perceptions of future risk after low-energy fractures at midlife. Ann Fam Med 3:64–69

    Article  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to B. Merle.

Ethics declarations

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

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merle, B., Dupraz, C., Haesebaert, J. et al. Osteoporosis prevention: where are the barriers to improvement in a French general population? A qualitative study. Osteoporos Int 30, 177–185 (2019). https://doi.org/10.1007/s00198-018-4720-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-018-4720-5

Keywords

Navigation