Alami Sophie, Hervouet Lucile, Poiraudeau Serge, Briot Karine, Roux Christian
Interlis, Paris, France.
Centre de Sociologie des Organisations, Institut des Sciences Politiques, UMR 7116, CNRS, Paris, France.
PLoS One. 2016 Jun 29;11(6):e0158365. doi: 10.1371/journal.pone.0158365. eCollection 2016.
Only a minority of patients at high risk for osteoporotic fracture receive treatment.
Study patients' and physicians' views regarding postmenopausal osteoporosis (PMO) to identify impediments to good care.
A qualitative study involving 18 physicians and 37 women (age 57-87) with PMO.
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.
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.
仅有少数骨质疏松性骨折高危患者接受治疗。
研究患者和医生对绝经后骨质疏松症（PMO）的看法，以确定优质护理的障碍因素。
一项定性研究，涉及18名医生和37名患有PMO的女性（年龄57 - 87岁）。
所有接受访谈的女性都认为PMO在一定程度上是与老年相关的正常磨损。这些女性确定了大量骨质疏松症的“病因”，但最终认为这是偶然因素。她们都描述其进展缓慢。确定了三种PMO严重程度的表现形式：一些女性倾向于将其解释为良性（21人），另一些女性倾向于夸大其严重性（11人），其余的则不确定（5人）。这些表现形式似乎与年龄或骨折无关。即使是那些将骨折与PMO联系起来的女性，也不确定两者之间的联系。骨折被认为是随机事件，与骨质疏松症无关。女性积极接受医生给出的一般生活方式建议，但并未将其与骨质疏松症具体联系起来。实际上，这些建议，以及对副作用的恐惧、治疗缺乏切实效果、将PMO视为自然过程的观点以及PMO严重程度的表现形式，都是可能阻碍治疗并影响依从性的因素。至于医生，他们确定了八个风险因素，认识到绝经是PMO的核心因素，并认识到骨折风险与PMO之间的联系。然而，一些医生认为骨折的影响在时间上是有限的，并将PMO视为一种“良性”疾病。与其他疾病相比，将PMO的进展视为缓慢且不可避免降低了他们诊断和治疗的紧迫性。一些医生承认对现有治疗手段掌握有限，且在处理患者依从性方面不太成功。
女性和医生对PMO的看法趋于将绝经后骨质疏松症视为平常之事，从而使其失去作为一种合理疾病的资格。更好地理解女性和医生与PMO相关的看法、做法和担忧，可改善骨质疏松症的管理。
