title: Why do women reject bisphosphonates for osteoporosis? A videographic study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mayo Medical School, Rochester, Minnesota, United States of America.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Scoville
authors.forename: Paula
authors.initials: P
authors.lastname: Ponce de Leon Lovaton
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Pencille
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000328:Adult; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003657:Decision Making; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates