title: Barriers to Effective Postmenopausal Osteoporosis Treatment: A Qualitative Study of Patients' and Practitioners' Views.
abstract: BACKGROUND
  Only a minority of patients at high risk for osteoporotic fracture receive treatment.
  
  
  OBJECTIVE
  Study patients' and physicians' views regarding postmenopausal osteoporosis (PMO) to identify impediments to good care.
  
  
  METHODS
  A qualitative study involving 18 physicians and 37 women (age 57-87) with PMO.
  
  
  RESULTS
  All women interviewed considered PMO to be somewhat normal wear-and-tear associated with old age. The women identified a large number of "causes" for osteoporosis but finally viewed it as chance. They all described its progression as slow. Three representations of PMO severity were identified: some women tended to interpreted it as benign (21), others tended to dramatize it (11), and the rest were uncertain (5). These representations did not appear linked to age or fracture. Even the women who associated fracture and PMO were uncertain of the link between them. Fractures were considered to be random events, independent of osteoporosis. Women received general life-style recommendations from their physicians positively, but did not connect them specifically to osteoporosis. Indeed, these recommendations, along with the fear of side effects, the absence of tangible results of treatments, the view of PMO as a natural process, and the representations of PMO severity are factors that may deter treatments and impact compliance. As for the physicians, they identified eight risk factors, recognizing menopause as central to PMO and recognized the link between risk of fracture and PMO. However, some considered the impact of fractures to be limited in time, and viewed PMO as a "benign" disease. Seeing the progression of PMO as slow and inevitable reduced their urgency to diagnose and treat it as compared to other diseases. Some physicians acknowledged limited mastery of the existing therapeutic arsenal and unsuccessful handling of patient compliance.
  
  
  CONCLUSIONS
  Women's and physicians' perspectives on PMO converged to trivialize postmenopausal osteoporosis and thus disqualify it as a legitimate disease. A better understanding of women's and physicians' views, practices, and concerns related to PMO can improve osteoporosis management.
authors.affiliation: Interlis, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Alami
authors.affiliation: Centre de Sociologie des Organisations, Institut des Sciences Politiques, UMR 7116, CNRS, Paris, France.
authors.forename: Lucile
authors.initials: L
authors.lastname: Hervouet
authors.affiliation: U1153 Institut National de la Santé et de la Recherche Médicale; PRES Sorbonne Paris Cité, Université Paris Descartes; Service de Rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Poiraudeau
authors.affiliation: U1153 Institut National de la Santé et de la Recherche Médicale; PRES Sorbonne Paris Cité, Université Paris Descartes; Service de Rhumatologie B, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Karine
authors.initials: K
authors.lastname: Briot
authors.affiliation: U1153 Institut National de la Santé et de la Recherche Médicale; PRES Sorbonne Paris Cité, Université Paris Descartes; Service de Rhumatologie B, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000523:psychology / Q000628:therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control* / Q000523:psychology; D010820:Physicians; D036301:Qualitative Research; D012307:Risk Factors