Patient treatment preferences for osteoporosis.
OBJECTIVE
To examine patient preferences for currently available and promising osteoporosis treatment options.


METHODS
We recruited patients who had recently (within 2 weeks) undergone bone densitometry and were found to have osteoporosis. Consenting participants completed an Adaptive Conjoint Analysis questionnaire to determine their treatment preferences for oral bisphosphonates taken once per week, intravenous bisphosphonates administered every 3 months, intravenous bisphosphonates administered once per year, and subcutaneous recombinant human parathyroid hormone (rhPTH). We performed simulations based on respondents' values for route of administration, absolute reduction in risk of vertebral and hip fractures over 5 years, and risk of adverse effects to predict each respondent's treatment choice.


RESULTS
The study sample included 201 women and 11 men (median age 73). Patients' treatment preferences were strongly influenced by route of administration. Patients' preferred treatment option, across all simulations, was bisphosphonates. Among 80 treatment-naive participants, 52 (65%) preferred an annual infusion over oral weekly bisphosphonates. Participants with poorer perceived health status, those with a high perceived risk of future fracture, and participants preferring to treat health problems without doctors or prescription drugs were more likely to prefer an annual infusion over weekly pills.


CONCLUSIONS
Patient preferences for osteoporosis treatment options are strongly influenced by route of administration. Therefore, despite the added benefits of rhPTH, patients' preferred treatment option for osteoporosis is bisphosphonates. Among those preferring bisphosphonates, many preferred annual infusions over weekly oral medications, emphasizing the need to incorporate individual patient preferences into treatment decisions for osteoporosis. The latter is especially important given the poor rates of long-term adherence to osteoporosis medications.
Fraenkel
Liana
L
Yale University School of Medicine, Section of Rheumatology, New Haven, CT 06520-8031, USA. liana.fraenkel@yale.edu
Gulanski
Barbara
B
Wittink
Dick
D
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D019538:Health Care Surveys; D006801:Humans; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D017060:Patient Satisfaction; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D018570:Risk Assessment; D011795:Surveys and Questionnaires
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; C470125:PTH protein, human; D010281:Parathyroid Hormone; D011994:Recombinant Proteins