title: Differing perceptions of intervention thresholds for fracture risk: a survey of patients and doctors.
abstract: This survey suggests that patients are prepared to accept higher absolute fracture risk than doctors, before considering pharmacological therapy to be justified. Patients require that drug treatments confer substantial fracture risk reductions in order to consider long-term therapy.
  
  
  BACKGROUND
  Absolute fracture risk estimates are now incorporated into osteoporosis treatment guidelines. At present, little is known about how patients regard fracture risk and its management. We set out to describe and compare the views of patients and doctors on the level of fracture risk at which drug treatment is justified.
  
  
  METHODS
  A cross-sectional survey was conducted on 114 patients referred for bone density measurement and 161 doctors whose practice includes management of osteoporosis. Participants were asked about fracture risk thresholds for pharmacological intervention.
  
  
  RESULTS
  The absolute risk of both major osteoporotic fracture and hip fracture at which drug treatment was considered by patients to be justifiable was higher than that reported by doctors [major osteoporotic fracture, median (interquartile range): patients, 50% (25 to 60); doctors, 10% (10 to 20); P < 0.0001; hip fracture: patients, 50% (25 to 60); doctors, 10% (5 to 20); P < 0.0001]. Patients required that a drug provide a median 50% reduction in relative risk of fracture in order to consider taking long-term therapy, irrespective of the treatment mode or dosing schedule. Among doctors, there was an inverse relationship between the number of osteoporosis consultations conducted each month and threshold of risk for recommending drug treatment (r = -0.22 and r = -0.29 for major osteoporotic fracture and hip fracture, respectively, P < 0.01 for both)
  
  
  CONCLUSIONS
  Patients are prepared to accept higher absolute fracture risk than doctors, before considering pharmacological therapy to be justified. Patients require that drug treatments confer substantial fracture risk reductions in order to consider long-term therapy.
authors: Department of Medicine, University of Auckland, Auckland,New Zealand.
authors: F
authors: F
authors: Douglas
authors: K J
authors: KJ
authors: Petrie
authors: T
authors: T
authors: Cundy
authors: A
authors: A
authors: Horne
authors: G
authors: G
authors: Gamble
authors: A
authors: A
authors: Grey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D001134:Arm Injuries / Q000517:prevention & control; D001291:Attitude of Health Personnel; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D002118:Calcium / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D000069448:Denosumab; D019587:Dietary Supplements; D004164:Diphosphonates / Q000008:administration & dosage; D005260:Female; D006620:Hip Fractures / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D007869:Leg Injuries / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000188:drug therapy / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D010384:Pelvic Bones / Q000293:injuries; D018570:Risk Assessment; D012784:Shoulder Fractures / Q000517:prevention & control; D016103:Spinal Fractures / Q000517:prevention & control; D011795:Surveys and Questionnaires; D019379:Teriparatide / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D019379:Teriparatide; D000069448:Denosumab; D002118:Calcium