Wozniak L A, Johnson J A, McAlister F A, Beaupre L A, Bellerose D, Rowe B H, Majumdar S R
School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, T6G 2E1, Edmonton, Alberta, Canada.
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Osteoporos Int. 2017 Jan;28(1):219-229. doi: 10.1007/s00198-016-3693-5. Epub 2016 Jul 16.
We aimed to understand how patients 50 years and older decided to persist with or stop osteoporosis (OP) treatment. Processes related to persisting with or stopping OP treatments are complex and dynamic. The severity and risks and harms related to untreated clinical OP and the favorable benefit-to-risk profile for OP treatments should be reinforced.
Older adults with fragility fracture and clinical OP are at high risk of recurrent fracture, and treatment reduces this risk by 50 %. However, only 20 % of fracture patients are treated for OP and half stop treatment within 1 year. We aimed to understand how older patients with new fractures decided to persist with or stop OP treatment over 1 year.
We conducted a grounded theory study of patients 50 years and older with upper extremity fracture who started bisphosphonates and then reported persisting with or stopping treatment at 1 year. We used theoretical sampling to identify patients who could inform emerging concepts until data saturation was achieved and analyzed these data using constant comparison.
We conducted 21 interviews with 12 patients. Three major themes emerged. First, patients perceived OP was not a serious health condition and considered its impact negligible. Second, persisters and stoppers differed in weighting the risks vs benefits of treatments, where persisters perceived less risk and more benefit. Persisters considered treatment "required" while stoppers often deemed treatment "optional." Third, patients could change treatment status even 1-year post-fracture because they re-evaluated severity and impact of OP vs risks and benefits of treatments over time.
The processes and reasoning related to persisting with or stopping OP treatments post-fracture are complex and dynamic. Our findings suggest two areas of leverage for healthcare providers to reinforce to improve persistence: (1) the severity and risks and harms related to untreated clinical OP and (2) the favorable benefit-to-risk profile for OP treatments.
我们旨在了解50岁及以上的患者如何决定继续或停止骨质疏松症（OP）治疗。与继续或停止OP治疗相关的过程复杂且动态变化。应强化与未经治疗的临床OP相关的严重程度、风险及危害，以及OP治疗良好的风险效益比。
患有脆性骨折和临床OP的老年人再次骨折的风险很高，治疗可将此风险降低50%。然而，只有20%的骨折患者接受OP治疗，且其中一半在1年内停止治疗。我们旨在了解新发骨折的老年患者在1年时间里是如何决定继续或停止OP治疗的。
我们对50岁及以上上肢骨折且开始使用双膦酸盐治疗，之后报告在1年时继续或停止治疗的患者进行了扎根理论研究。我们采用理论抽样来确定能够为新出现的概念提供信息的患者，直至达到数据饱和，并使用持续比较法对这些数据进行分析。
我们对12名患者进行了21次访谈。出现了三个主要主题。第一，患者认为OP不是严重的健康状况，其影响可忽略不计。第二，继续治疗者和停止治疗者在权衡治疗的风险与益处方面存在差异，继续治疗者认为风险较小而益处较大。继续治疗者认为治疗“必要”，而停止治疗者通常认为治疗“可选择”。第三，患者即使在骨折1年后也可能改变治疗状态，因为随着时间推移，他们会重新评估OP的严重程度和影响以及治疗的风险与益处。
骨折后继续或停止OP治疗的过程及推理复杂且动态变化。我们的研究结果表明，医疗服务提供者可通过强化两个方面来提高治疗依从性：（1）与未经治疗的临床OP相关的严重程度、风险及危害；（2）OP治疗良好的风险效益比。
