Background Osteoporosis (OP) is a common chronic condition in postmenopausal women. Recent studies indicate that 10%1 to 46%2 of postmenopausal patients are not pharmacologically treated for OP post diagnosis. Reasons for non-treatment among recently diagnosed OP patients are not well understood.
Objectives To understand the physician perspective for not providing pharmacological treatment to women recently diagnosed with OP in France.
Methods An online survey was conducted among physicians from Nov 21-Dec 22 2014. The survey evaluated physician perceptions toward the screening, diagnosis, and management of OP. Physicians also completed a patient chart review by randomly selecting at least 3 patient charts that met all of the following criteria: postmenopausal female; diagnosed with OP within the past 3 to 12 months; not yet prescribed prescription OP medications. Patient clinical characteristics, OP risk factors, and reasons for non-treatment were collected for each chart reviewed.
Results 144 physicians completed the survey (67 primary care physicians, 30 geriatricians, and 47 rheumatologists) and data from 544 untreated postmenopausal OP patients charts were obtained. On average, 30% of postmenopausal women who had been newly diagnosed with OP were not pharmacologically treated for OP. Based on data from the patient charts, the majority of untreated patients (63%) were over age 60; 71% were diagnosed via bone mineral density scans (average t-score: -2.7) and had been diagnosed for an average of 6.2 months (median: 6 months). The primary reason for non-treatment was patient driven [patient pushed back on the recommended prescription (56%, n=306)], rather than physician driven, [physician decided not to prescribe (44%, n=238)]. The most frequently mentioned reasons for patient pushback included concerns of medication side-effects (56%), lack of understanding OP risks (30%), poly-pharmacy (25%), questioning the potential benefit of taking medication (25%), consideration of non-prescription options before prescription medications (24%), and difficulty in adhering to medication routine (23%). Physicians decided not to prescribe due to patients' low calcium and/or vitamin D levels (25%), polypharmacy (22%), borderline patient cases (t-score of -2.5 or -3.0 with no risk factors; 21%), and pre-existing gastrointestinal (GI) problems (20%) [Figure]. For 49% of untreated patients, physicians intended to address patient concerns regarding the OP medications during the next patient visit.
Conclusions The absence of treatment for OP is driven by several patient and physician-driven factors. For patients, resistance included concerns about medication related side effects (56%) and patients' lack of understanding of the risks of OP (30%). Clinical issues such as low calcium and/or Vitamin D levels (25%), poly-pharmacy (22%), borderline cases of OP (21%), and pre-existing GI problems (20%) were the major physician-led reasons for non-treatment.
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Modi A, Fan T, Sajjan S, Rajagopalan S, Sen S. Characteristics and treatment initiation among women diagnosed with osteoporosis in France. Osteoporosis International. 2012;23:S194.
Acknowledgements This research was funded by Merck, Inc USA.
Disclosure of Interest K. Olsson Employee of: Evidera, R. Sadasivan Employee of: Evidera, J. Weaver Employee of: Merck, S. Sen Employee of: Merck, A. Modi Employee of: Merck
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