title: Non-pharmacological strategies used by patients at high risk for future fracture to manage fracture risk--a qualitative study.
abstract: We examined patients' self-management of bone health and fracture risk, particularly behaviors other than medication use and seeking diagnostic testing. Awareness of fracture risk was accompanied by positive lifestyle changes in participants' lives such as being careful. Future research should evaluate how lifestyle changes mitigate fracture risk.
  
  
  BACKGROUND
  We examined patients' understanding of bone health and self-management decisions regarding bone health and fracture risk, particularly behaviors other than medication use and seeking diagnostic testing.
  
  
  METHODS
  A phenomenological (qualitative) study was conducted. English-speaking patients, 65+ years old, who were "high risk" for future fracture and prescribed pharmacotherapy after being screened through a post-fracture osteoporosis initiative were eligible. Patients were interviewed for 1-2 h and were asked to discuss perceptions of bone health status (bone densitometry results and perceived fracture risk), recommendations received for bone health, and lifestyle changes since their most recent fracture. We analyzed the data guided by Giorgi's methodology.
  
  
  RESULTS
  We interviewed 21 fracture patients (6 males and 15 females), aged 65 to 88 years old. With the exception of one participant, all participants appeared to understand that they had low bone mass and were at risk of sustaining another fracture. Most participants (n = 20) were predominantly concerned about being careful, and they focused their responses on personal and environmental factors that they perceived to be modifiable. Participants also spoke about strategies to manage their bone health such as exercise, having a healthy diet and taking supplements, and using aids and devices. Non-pharmacological strategies used by patients appeared to be independent of current use of pharmacotherapy.
  
  
  CONCLUSIONS
  Awareness of fracture risk was accompanied by a number of positive lifestyle changes in participants' lives such as being careful and engaging in exercise. Future research needs to evaluate how lifestyle changes such as being careful mitigate fracture risk.
authors.affiliation: Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, St. Michael's, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada, salej@smh.ca.
authors.forename: J E M
authors.initials: JE
authors.lastname: Sale
authors.forename: M A
authors.initials: MA
authors.lastname: Gignac
authors.forename: G
authors.initials: G
authors.lastname: Hawker
authors.forename: D
authors.initials: D
authors.lastname: Beaton
authors.forename: E
authors.initials: E
authors.lastname: Bogoch
authors.forename: F
authors.initials: F
authors.lastname: Webster
authors.forename: L
authors.initials: L
authors.lastname: Frankel
authors.forename: V
authors.initials: V
authors.lastname: Elliot-Gibson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004032:Diet; D019587:Dietary Supplements; D015444:Exercise; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D009864:Ontario; D010024:Osteoporosis / Q000523:psychology / Q000534:rehabilitation*; D058866:Osteoporotic Fractures / Q000517:prevention & control* / Q000523:psychology; D036301:Qualitative Research; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D012656:Self-Help Devices / Q000706:statistics & numerical data