Fracture risk perception study: patient self-perceptions of bone health often disagree with calculated fracture risk.
BACKGROUND
We sought to evaluate the concordance between self-assessed perceptions of fracture risk and actual risk calculated by World Health Organization's 10-year Fracture Risk Assessment Tool (FRAX).


METHODS
We collected demographic data, lifestyle information, osteoporosis knowledge, bone density test results, and treatment history from patients aged 50 to 75 years. Subjects rated their perceptions of 10-year risk of sustaining fracture as low (0%-9%), intermediate (10%-19%), or high (≥20%). This rating was compared with risk calculated by FRAX.


RESULTS
Among 426 patients, the greatest agreement regarding fracture risk was noted for those in the low-risk FRAX group: 81% perceived themselves as having low risk. The most risk disagreement was in the high-risk FRAX group: Only 18% perceived their risk as high. Perceived risk was intermediate for 59% and low for 24%. Of patients at intermediate calculated risk by FRAX, 48% agreed with this with self-perceived risk. Overall, risk agreement was associated with bone density results, with higher T scores predictive of agreement. Underestimation was associated with being female and older. Patients with prescription treatment exposure frequently had risk disagreement and perceived their risk as lower than their calculated FRAX scores might indicate. Patients taking calcium and vitamin D similarly perceived lower risk than calculated by FRAX.


CONCLUSIONS
Patients at intermediate and high calculated fracture risk frequently had self-perceptions of lower risk. Patients taking prescription osteoporosis medication and calcium and vitamin D treatment perceived less risk than calculated. Whether correcting misperceptions about personal susceptibility to fracture might result in behavioral changes will be determined.
Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona. Electronic address: grover.michael@mayo.edu.
Michael L
ML
Grover
Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona.
Frederick D
FD
Edwards
Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona.
Yu-Hui H
YH
Chang
Divisions of Endocrinology and Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Scottsdale, Arizona.
Curtiss B
CB
Cook
Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona.
Margaret C
MC
Behrens
Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona.
Amylou C
AC
Dueck
D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000000981:diagnostic imaging; D010361:Patients / Q000523:psychology; D010465:Perception; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012649:Self Concept; D057566:Self Report; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires