Clinical and demographic factors determining patient fracture risk decision point (FRDP): The improving risk communication in osteoporosis (RICO) project

Mitali Sharma; Charlotte Beaudart; Patricia Clark; Saeko Fujiwara; Jonathan D Adachi; Alexandra Papaioannou; Osvaldo D Messina; Suzanne N Morin; Lynn Kohlmeier; Xavier Nogues; Carolyn Leckie; Nicholas C Harvey; John A Kanis; Jean-Yves Reginster; Mickael Hiligsmann; Stuart L Silverman

doi:10.1007/s00198-024-07264-5

Clinical and demographic factors determining patient fracture risk decision point (FRDP): The improving risk communication in osteoporosis (RICO) project

Osteoporos Int. 2024 Oct 21. doi: 10.1007/s00198-024-07264-5. Online ahead of print.

Authors

Mitali Sharma¹, Charlotte Beaudart^{2

3}, Patricia Clark⁴, Saeko Fujiwara⁵, Jonathan D Adachi⁶, Alexandra Papaioannou⁶, Osvaldo D Messina^{7

8}, Suzanne N Morin⁹, Lynn Kohlmeier¹⁰, Xavier Nogues¹¹, Carolyn Leckie⁶, Nicholas C Harvey^{12

13}, John A Kanis^{14

15}, Jean-Yves Reginster^{3

16}, Mickael Hiligsmann², Stuart L Silverman^{17

18}

Affiliations

¹ The OMC Research Center, Beverly Hills, CA, USA. [email protected].
² Department of Health Services Research, CAPHRI Care & Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
³ Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium.
⁴ Clinical Epidemiology Unit, Faculty of Medicine UNAM, Children's Hospital of Mexico Federico Gomez, Mexico City, Mexico.
⁵ Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
⁶ McMaster University, Hamilton, ON, Canada.
⁷ Investigaciones Reumatológicas y Osteológicas (IRO). Collaborating Centre WHO, Buenos Aires, Argentina.
⁸ IRO Medical Center, Investigaciones Reumatologicas y Osteologicas SRL, Buenos Aires, Argentina.
⁹ Department of Medicine, McGill University, Montreal, Canada.
¹⁰ Spokane Osteoporosis and Endocrinology, Spokane, WA, USA.
¹¹ Internal Medicine Department, CIBERFES (ISCIII), Hospital del Mar Research Institute, Pompeu Fabra University, Barcelona, Spain.
¹² MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, UK.
¹³ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, UK.
¹⁴ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
¹⁵ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
¹⁶ Protein Research Chair, Biochemistry Dept, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
¹⁷ The OMC Research Center, Beverly Hills, CA, USA.
¹⁸ Cedars-Sinai Medical Center, Los Angeles, CA, USA.

PMID: 39432087
DOI: 10.1007/s00198-024-07264-5

Abstract

This study aims to understand how osteoporosis medication acceptance varies across countries with differing guidance on treatment threshold and influence of clinical and demographic factors. A total of 79.2% accepted treatment at a fracture probability at or below the treatment threshold. Fracture history and age did not strongly impact acceptance, suggesting a need for improved fracture risk communication.

Purpose: This part of the Improving Risk Communication in Osteoporosis (RICO) study aims to understand patients' willingness to initiate osteoporosis treatment given a hypothetical fracture probability-derived from the FRAX® Risk Assessment Tool-and how age, fracture history, and numeric literacy may influence this.

Methods: In 2022-2023, 332 postmenopausal women at risk of fracture were interviewed from nine countries to determine participants' Fracture Risk Decision Point (FRDP), the lowest probability of major osteoporotic fracture at which they would accept an osteoporosis medication. Participants' FRDP was evaluated given eight hypothetical 10-year FRAX scores.

Results: In countries with FRAX-based treatment thresholds, over half of the participants per country reported an FRDP that was below the threshold. Collectively, 79.2% demonstrated FRDPs at or below their respective threshold. Age and fracture history did not have a strong influence on FRDP; however, those who demonstrated higher levels of numeric literacy reported a significantly higher median FRDP (10%) compared to those who showed lower levels (5%, p < 0.001).

Conclusions: Most patients were willing to accept an osteoporosis medication prescription at a hypothetical FRAX probability that was even lower than that of their nationally recommended treatment threshold. Literacy scores had a significant influence on FRDP whereas age and fracture history did not.

Keywords: FRAX® probability; Fracture Risk Decision Point (FRDP); Osteoporosis; Patient willingness to accept treatment; Treatment threshold.