OSTEOPOROSIS CHOICEDecision Aid

Spyridoula Maraka, MD

Mayo Clinic

CLINICAL CASE

67 year-old Caucasian female comes for preventive medicine visit

History significant for type 2 diabetes-well controlled on metformin

No personal/family history of fracture No history of malabsorption or thyroid

disease Menopause 15 years ago, no hormone

replacement therapy Denies alcohol/smoking Two dairy servings/day, calcium carbonate

600 mg+vitamin D 1000 IU daily

CLINICAL CASE (con’t)

25-hydroxy Vitamin D level 35 ng/mL, normal CBC, calcium level, and electrolytes

Bone density:– Left femur neck T-score: -2.2– Right femur neck T-score: -2.6– Lumbar spine T-score: - 2.9

INTRODUCTION

Bisphosphonates can reduce the risk of osteoporotic fracture in postmenopausal women

Many women at high risk for fractures choose not to initiate treatment

Up to 50% of women discontinue treatment in less than 1 year

INTRODUCTION

Failure to reduce the risk of osteoporotic fractures can increase healthcare costs and decrease quality of life/life expectancy

Poor adherence: due to unexplored patient values or lack of understanding of the efficacy and safety of treatment

Decision aids: effective at improving knowledge acquisition and reducing so-called decisional conflict

Osteoporosis Choice

Single-sheet printed decision aid– Pictograph of patient’s estimated 10-year

risk of a major fragility fracture (using FRAX)

– Pictograph of how this risk is reduced by bisphosphonates

– List of adverse effects– Estimation of oral bisphosphonates out-

of-pocket costs Designed for use between patients and

their clinicians

Osteoporosis Choice

Improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women

Did not affect start rates May have improved adherence

CALCULATE RISK

Type 1 diabetes, premature

menopause, chronic

malabsorption, hyperthyroidis

m, hypogonadism

BACK TO OUR CASE..

Major Osteoporotic Fracture-10 year risk

Hip Fracture-10 year risk

Intervention

Intervention

Issues

Issues

Issues

Notes

Questions

What is the potential value of shared decision making and the use of osteoporosis treatment decision aids in osteoporosis in the context of quality improvement strategies and pay for performance systems?

http://osteoporosisdecisionaid.mayoclinic.org/