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Published in: Archives of Osteoporosis 1-2/2012

01-12-2012 | Original Article

General medical practitioners' knowledge and beliefs about osteoporosis and its investigation and management

Authors: Renée Otmar, Susanne D. Reventlow, Geoffrey C. Nicholson, Mark A. Kotowicz, Julie A. Pasco

Published in: Archives of Osteoporosis | Issue 1-2/2012

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Abstract

Summary

This qualitative study explored beliefs and attitudes regarding osteoporosis and its management. General medical practitioners (GPs) were ambivalent about osteoporosis due to concern about financial barriers for patients and their own beliefs about the salience of osteoporosis. GPs considered investigation and treatment in the context of patients' whole lives.

Purpose

We aimed to investigate barriers, enablers, and other factors influencing the investigation and management of osteoporosis using a qualitative approach. This paper analyses data from discussions with general medical practitioners (GPs) about their beliefs and attitudes regarding osteoporosis and its management.

Methods

Fourteen GPs and two practice nurses aged 27–89 years participated in four focus groups, from June 2010 to March 2011. Each group comprised 3–5 participants, and discussions were semi-structured, according to the protocol developed for the main study. Discussion points ranged from the circumstances under which GPs would initiate investigation for osteoporosis and their subsequent actions to their views about treatment efficacy and patient adherence to prescribed treatment. Audio recordings were transcribed and coded for analysis using analytic comparison to identify the major themes.

Results

The GPs were not particularly concerned about osteoporosis in their patients or the general population, ranking diabetes, osteoarthritis, cardiovascular disease, and hypertension higher than concern about osteoporosis. They expressed confidence in the efficacy of anti-fracture medications but were concerned about the potential financial burden on patients with limited incomes. The GPs were unsure about guidelines for investigation and management of osteoporosis in men and the appropriate duration of treatment, particularly for the bisphosphonates in all patients.

Conclusions

The GPs' ambivalence about osteoporosis appeared to stem from structural factors such as financial barriers for patients and their own beliefs about the salience of osteoporosis. GPs considered the impact of investigating and prescribing treatment in the context of patients' whole lives.
Literature
1.
go back to reference Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRef Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRef
2.
go back to reference Alonso-Coello P, Lopez A, Pencille LJ (2009) Is too much intervention recommended in the ACP osteoporosis treatment guidelines? Letter to the editor. Ann Intern Med 150:285–286 Alonso-Coello P, Lopez A, Pencille LJ (2009) Is too much intervention recommended in the ACP osteoporosis treatment guidelines? Letter to the editor. Ann Intern Med 150:285–286
3.
go back to reference Lock CA, Lecouturier J, Mason JM, Dickinson HO (2005) Lifestyle interventions to prevent osteoporotic fractures: a systematic review. Osteoporos Int 17:20–28PubMedCrossRef Lock CA, Lecouturier J, Mason JM, Dickinson HO (2005) Lifestyle interventions to prevent osteoporotic fractures: a systematic review. Osteoporos Int 17:20–28PubMedCrossRef
4.
go back to reference Sanders KM, Nicholson GC, Watts JJ, Pasco JA, Henry MJ, Kotowicz MA, Seeman E (2006) Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective? Bone 38:694–700PubMedCrossRef Sanders KM, Nicholson GC, Watts JJ, Pasco JA, Henry MJ, Kotowicz MA, Seeman E (2006) Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective? Bone 38:694–700PubMedCrossRef
5.
go back to reference Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD (2007) Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 24:37–55PubMedCrossRef Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD (2007) Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 24:37–55PubMedCrossRef
6.
go back to reference Chiang A, Jones J, Humphreys J, Martin C (2006) Osteoporosis: diagnosis and treatment in a general practice population. Aust Fam Physician 35:166–168PubMed Chiang A, Jones J, Humphreys J, Martin C (2006) Osteoporosis: diagnosis and treatment in a general practice population. Aust Fam Physician 35:166–168PubMed
7.
go back to reference Inderjeeth CA, Glennon D, Petta A (2006) Study of osteoporosis awareness, investigation and treatment of patients discharged from a tertiary public teaching hospital. Intern Med J 36:547–551PubMedCrossRef Inderjeeth CA, Glennon D, Petta A (2006) Study of osteoporosis awareness, investigation and treatment of patients discharged from a tertiary public teaching hospital. Intern Med J 36:547–551PubMedCrossRef
8.
go back to reference Richardson JC, Hassell AB, Thomas E, Hay EM (2004) GPs' perceptions of the role of DEXA scanning: an exploratory study. Fam Pract 21:51–53PubMedCrossRef Richardson JC, Hassell AB, Thomas E, Hay EM (2004) GPs' perceptions of the role of DEXA scanning: an exploratory study. Fam Pract 21:51–53PubMedCrossRef
9.
go back to reference Rizzoli R, Brandi ML, Dreinhofer K, Thomas T, Wahl DA, Cooper C (2010) The gaps between patient and physician understanding of the emotional and physical impact of osteoporosis. Arch Osteoporos 5:145–153CrossRef Rizzoli R, Brandi ML, Dreinhofer K, Thomas T, Wahl DA, Cooper C (2010) The gaps between patient and physician understanding of the emotional and physical impact of osteoporosis. Arch Osteoporos 5:145–153CrossRef
10.
go back to reference Reventlow S, Bang H (2006) Brittle bones: ageing or threat of disease—exploring women's cultural models of osteoporosis. Scand J Public Health 34:320–326PubMedCrossRef Reventlow S, Bang H (2006) Brittle bones: ageing or threat of disease—exploring women's cultural models of osteoporosis. Scand J Public Health 34:320–326PubMedCrossRef
11.
go back to reference Reventlow S, Overgaard I, Hvas L, Malterud K (2008) Metaphorical mediation in women's perceptions of risk related to osteoporosis: a qualitative interview study. Health Risk Soc 10:103–115CrossRef Reventlow S, Overgaard I, Hvas L, Malterud K (2008) Metaphorical mediation in women's perceptions of risk related to osteoporosis: a qualitative interview study. Health Risk Soc 10:103–115CrossRef
12.
go back to reference Skolbekken J-A, Østerlie W, Forsmo S (2008) Brittle bones, pain and fractures—lay constructions of osteoporosis among Norwegian women attending the Nord-Trøndelag Health Study (HUNT). Soc Sci Med 66:2562–2572PubMedCrossRef Skolbekken J-A, Østerlie W, Forsmo S (2008) Brittle bones, pain and fractures—lay constructions of osteoporosis among Norwegian women attending the Nord-Trøndelag Health Study (HUNT). Soc Sci Med 66:2562–2572PubMedCrossRef
13.
go back to reference Kanis J, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6:1–146PubMed Kanis J, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6:1–146PubMed
14.
go back to reference Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F, Rizzoli R (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428PubMedCrossRef Kanis JA, Burlet N, Cooper C, Delmas PD, Reginster J-Y, Borgstrom F, Rizzoli R (2008) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 19:399–428PubMedCrossRef
15.
go back to reference Werner P (2005) Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int 16:115–127PubMedCrossRef Werner P (2005) Knowledge about osteoporosis: assessment, correlates and outcomes. Osteoporos Int 16:115–127PubMedCrossRef
16.
go back to reference Edwards L, Fraser M (1997) How do we increase awareness of osteoporosis? Balliere Clin Rheumatol 11:631–644CrossRef Edwards L, Fraser M (1997) How do we increase awareness of osteoporosis? Balliere Clin Rheumatol 11:631–644CrossRef
17.
go back to reference Werner P, Vered I (2002) The diagnosis of osteoporosis: attitudes and knowledge of Israeli physicians. Aging Clin Exp Res 14:52–59PubMed Werner P, Vered I (2002) The diagnosis of osteoporosis: attitudes and knowledge of Israeli physicians. Aging Clin Exp Res 14:52–59PubMed
18.
go back to reference Australian Bureau of Statistics (2007) Census of Population and Housing 2006. Commonwealth of Australia, Canberra Australian Bureau of Statistics (2007) Census of Population and Housing 2006. Commonwealth of Australia, Canberra
19.
go back to reference Kitzinger J (2006) Focus groups. In: Pope C, Mays N (eds) Qualitative research in health care, 3rd edn. Blackwell Publishing, Oxford, UK Kitzinger J (2006) Focus groups. In: Pope C, Mays N (eds) Qualitative research in health care, 3rd edn. Blackwell Publishing, Oxford, UK
20.
go back to reference Bradley EH, Curry LA, Devers KJ (2007) Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 42:1758–1772PubMedCrossRef Bradley EH, Curry LA, Devers KJ (2007) Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 42:1758–1772PubMedCrossRef
21.
go back to reference World Medical Association (2008) World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. In, 59th General Assembly, Seoul, Korea edn. World Medical Association (2008) World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. In, 59th General Assembly, Seoul, Korea edn.
22.
go back to reference Neuman WL (2003) Social research methods: qualitative and quantitative methods. Allyn and Bacon, Boston, USA Neuman WL (2003) Social research methods: qualitative and quantitative methods. Allyn and Bacon, Boston, USA
23.
go back to reference Glaser BG, Strauss AL (1967) The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago, USA Glaser BG, Strauss AL (1967) The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago, USA
24.
go back to reference Boeije H (2002) A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 26:391–409CrossRef Boeije H (2002) A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Qual Quant 26:391–409CrossRef
25.
go back to reference Silverman D, Marvasti A (2008) Doing qualitative research: a comprehensive guide. Sage Publications, Thousand Oaks, CA Silverman D, Marvasti A (2008) Doing qualitative research: a comprehensive guide. Sage Publications, Thousand Oaks, CA
26.
go back to reference O'Neill S, MacLennan A, Bass S et al (2004) Clinical practice: guidelines for the management of postmenopausal osteoporosis for GPs. Aust Fam Physician 33:910–917PubMed O'Neill S, MacLennan A, Bass S et al (2004) Clinical practice: guidelines for the management of postmenopausal osteoporosis for GPs. Aust Fam Physician 33:910–917PubMed
27.
go back to reference Sturtridge W, Lentle B, Hanley DA (1996) Prevention and management of osteoporosis: Consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 2. The use of bone density measurement in the diagnosis and management of osteoporosis. Can Med Assoc J 155:924–929 Sturtridge W, Lentle B, Hanley DA (1996) Prevention and management of osteoporosis: Consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 2. The use of bone density measurement in the diagnosis and management of osteoporosis. Can Med Assoc J 155:924–929
28.
go back to reference Henry MJ, Pasco JA, Nicholson GC, Pocock NA, Kotowicz MA (2004) Reference ranges for bone densitometers adopted Australia-wide: Geelong Osteoporosis Study. Australas Radiol 48:473–475PubMedCrossRef Henry MJ, Pasco JA, Nicholson GC, Pocock NA, Kotowicz MA (2004) Reference ranges for bone densitometers adopted Australia-wide: Geelong Osteoporosis Study. Australas Radiol 48:473–475PubMedCrossRef
29.
go back to reference Henry MJ, Pasco JA, Korn S, Gibson JE, Kotowicz MA, Nicholson GC (2010) Bone mineral density reference ranges for Australian men: Geelong Osteoporosis Study. Osteoporos Int 21:909–917PubMedCrossRef Henry MJ, Pasco JA, Korn S, Gibson JE, Kotowicz MA, Nicholson GC (2010) Bone mineral density reference ranges for Australian men: Geelong Osteoporosis Study. Osteoporos Int 21:909–917PubMedCrossRef
30.
go back to reference The Royal Australian College of General Practitioners R (2010) Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. In. RACGP, South Melbourne, Vic., Australia The Royal Australian College of General Practitioners R (2010) Clinical guideline for the prevention and treatment of osteoporosis in postmenopausal women and older men. In. RACGP, South Melbourne, Vic., Australia
32.
go back to reference Antonacci MD, Hanson DS, Heggeness MH (1996) Pitfalls in the measurement of bone mineral density by dual energy X-ray absorptiometry. Spine 21:87–91PubMedCrossRef Antonacci MD, Hanson DS, Heggeness MH (1996) Pitfalls in the measurement of bone mineral density by dual energy X-ray absorptiometry. Spine 21:87–91PubMedCrossRef
33.
go back to reference Walker-Bone K, Reid D, Cooper C (1998) Is screening for osteoporosis worthwhile? Br Med Bull 54:915–927PubMedCrossRef Walker-Bone K, Reid D, Cooper C (1998) Is screening for osteoporosis worthwhile? Br Med Bull 54:915–927PubMedCrossRef
34.
go back to reference Hruschka DJ, Hadley C (2008) A glossary of culture in epidemiology. J Epidemiol Community Health 62:947–951PubMedCrossRef Hruschka DJ, Hadley C (2008) A glossary of culture in epidemiology. J Epidemiol Community Health 62:947–951PubMedCrossRef
35.
go back to reference Gourlay M (2009) Osteoporosis screening: mixed messages in primary care. Am Fam Physician 79:189–190PubMed Gourlay M (2009) Osteoporosis screening: mixed messages in primary care. Am Fam Physician 79:189–190PubMed
36.
go back to reference Hiligsmann M, Gathon HJ, Bruyère O, Ethgen O, Rabenda V, Reginster JY (2010) Cost-effectiveness of osteoporosis screening followed by treatment: the impact of medication adherence. Value in Health: The Journal of The International Society For Pharmacoeconomics And Outcomes Research 13:394–401CrossRef Hiligsmann M, Gathon HJ, Bruyère O, Ethgen O, Rabenda V, Reginster JY (2010) Cost-effectiveness of osteoporosis screening followed by treatment: the impact of medication adherence. Value in Health: The Journal of The International Society For Pharmacoeconomics And Outcomes Research 13:394–401CrossRef
37.
go back to reference Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui L-Y, Ransohoff DF, Cauley JA, Ensrud KE (2012) Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 366:225–233PubMedCrossRef Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui L-Y, Ransohoff DF, Cauley JA, Ensrud KE (2012) Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 366:225–233PubMedCrossRef
38.
go back to reference Petursson H, Getz L, Sigurdsson JA, Heltlevik I (2009) Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population. BMC Family Practice 10: Petursson H, Getz L, Sigurdsson JA, Heltlevik I (2009) Current European guidelines for management of arterial hypertension: Are they adequate for use in primary care? Modelling study based on the Norwegian HUNT 2 population. BMC Family Practice 10:
39.
go back to reference Sambrook PN, Chen JS, Simpson JM, March LM (2010) Impact of adverse news media on prescriptions for osteoporosis: effect on fractures and mortality. Med J Aust 193:154–156PubMed Sambrook PN, Chen JS, Simpson JM, March LM (2010) Impact of adverse news media on prescriptions for osteoporosis: effect on fractures and mortality. Med J Aust 193:154–156PubMed
40.
go back to reference Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR (2008) Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. Br Med J 336:262–266CrossRef Bolland MJ, Barber PA, Doughty RN, Mason B, Horne A, Ames R, Gamble GD, Grey A, Reid IR (2008) Vascular events in healthy older women receiving calcium supplementation: randomized controlled trial. Br Med J 336:262–266CrossRef
41.
go back to reference Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC (2010) Annual high-dose oral vitamin D for falls and fractures in elderly women: a randomised controlled trial. J Am Med Assoc 303:1815–1822CrossRef Sanders KM, Stuart AL, Williamson EJ, Simpson JA, Kotowicz MA, Young D, Nicholson GC (2010) Annual high-dose oral vitamin D for falls and fractures in elderly women: a randomised controlled trial. J Am Med Assoc 303:1815–1822CrossRef
42.
go back to reference Reginster J-Y (2011) Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs 71:65–78PubMedCrossRef Reginster J-Y (2011) Antifracture efficacy of currently available therapies for postmenopausal osteoporosis. Drugs 71:65–78PubMedCrossRef
43.
go back to reference Schwarz P, Jorgensen NR, Mosekilde L, Vestergaard P (2011) The evidence for efficacy of osteoporosis treatment in men with primary osteoporosis: a systematic review and meta-analysis of antiresorptive and anabolic treatment in men. J Osteoporos 2011:259818PubMed Schwarz P, Jorgensen NR, Mosekilde L, Vestergaard P (2011) The evidence for efficacy of osteoporosis treatment in men with primary osteoporosis: a systematic review and meta-analysis of antiresorptive and anabolic treatment in men. J Osteoporos 2011:259818PubMed
44.
go back to reference Ringe JD, Doherty JG (2010) Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat. Rheumatol Int 30:863–869PubMedCrossRef Ringe JD, Doherty JG (2010) Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat. Rheumatol Int 30:863–869PubMedCrossRef
45.
go back to reference Åstrand J, Thorngren K-G, Tägil M, Åkesson K (2008) 3-year follow-up of 215 fracture patients from a prospective and consecutive osteoporosis screening program. Fracture patients care! Acta Orthop 79:404–409PubMedCrossRef Åstrand J, Thorngren K-G, Tägil M, Åkesson K (2008) 3-year follow-up of 215 fracture patients from a prospective and consecutive osteoporosis screening program. Fracture patients care! Acta Orthop 79:404–409PubMedCrossRef
46.
go back to reference Nielen MM, Assendelft WJ, Drenthen AJM, van den Hombergh P, van Dis I, Schellevis FG (2010) Primary prevention of cardio-metabolic diseases in general practice: a Dutch survey of attitudes and working methods of general practitioners. Eur J Gen Pract 16:139–142PubMedCrossRef Nielen MM, Assendelft WJ, Drenthen AJM, van den Hombergh P, van Dis I, Schellevis FG (2010) Primary prevention of cardio-metabolic diseases in general practice: a Dutch survey of attitudes and working methods of general practitioners. Eur J Gen Pract 16:139–142PubMedCrossRef
Metadata
Title
General medical practitioners' knowledge and beliefs about osteoporosis and its investigation and management
Authors
Renée Otmar
Susanne D. Reventlow
Geoffrey C. Nicholson
Mark A. Kotowicz
Julie A. Pasco
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
Archives of Osteoporosis / Issue 1-2/2012
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-012-0088-x

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