Why Do Women Reject Bisphosphonates for Osteoporosis? A Videographic Study

Despite access to effective, safe, and affordable treatment for osteoporosis, at-risk women may choose not to start bisphosphonate therapy. Understanding the reasons women give for rejecting a clinician's offer of treatment during consultations and how clinician's react to these reasons may help clinicians develop more effective strategies for fracture prevention and medication adherence.We conducted a videographic evaluation of encounters in the Osteoporosis Choice randomized trial of a decision aid about bisphosphonates vs. usual primary care. Eligible videos involved consultations with women with an estimated 10-year fragility fracture risk >20% who verbalized at least one reason to not take bisphosphonates. Two reviewers independently reviewed eligible videos and verbatim transcripts, classifying patient views about bisphosphonate use, clinicians response to those views, and patient adherence at 6 months post visit.Eighteen video recordings (12 with decision aid) were eligible for analyses. We identified 37 reasons for and against bisphosphonate therapy. Eleven patients rejected treatment, offering 9 (average of 2 per patient) unique reasons against initiating bisphosphonates (most common: side effects 39% and distrust of medications in general 33%). When physicians conceded to patient views the outcome was no bisphosphonate use. Adherence to choices at 6 months was 100%.The expression of patient preferences is sometimes unfavorable to bisphosphonates treatment even among well-informed patients at high risk for osteoporotic fractures. At 6 months, patients who expressed concerns about these medicines behaved consistently with the decision made during the visit

Frequency of patient verbalizations for and against bisphosphonate treatment as well as physician response style in relation to decision aid or control group.

<p>Frequency of patient verbalizations for and against bisphosphonate treatment as well as physician response style in relation to decision aid or control group.</p

Reasons to take or not take bisphosphonates.

<p>Most women gave multiple reasons for and against bisphosphonate therapy. This figure represents the overlap of multiple reasons presented during a single visit for patients who A) accepted treatment and B) rejected therapy.</p

Frequency of patient verbalizations for and against bisphosphonate treatment as well as physician response style in relation to acceptance or rejection of treatment.

<p>Frequency of patient verbalizations for and against bisphosphonate treatment as well as physician response style in relation to acceptance or rejection of treatment.</p

Clinician and patient characteristics.

<p>Clinician and patient characteristics.</p