WASHINGTON — A majority of women susceptible to fragility fractures fail to appreciate those risks, even if they have been told by a physician that they have osteoporosis, a large international survey-based study has concluded.
“We found a remarkable failure of many women to perceive that these clear-cut factors are putting them at increased risk for a fracture,” said Dr. Ethel Siris, an investigator for GLOW (Global Longitudinal Study of Osteoporosis in Women). “It's really a critique of the medical profession. We have not adequately educated women that osteoporosis is a common disorder that increases future fracture risk. They are just not getting the message.”
GLOW included more than 60,000 postmenopausal women who were recruited from 706 physician practices in 10 countries. The women completed questionnaires on demographic and medical information, risk factors for fragility fracture, any personal history of and treatment for osteoporosis, and health and functional status. Many of these questions were taken from the World Health Organization's Fracture Risk Assessment Tool (FRAX). A FRAX index score of 5 or more represents a 26% probability that a patient will experience a nonvertebral fracture within the next 5 years.
Comparing themselves with women of the same age, the majority of subjects with risk factors for fracture did not perceive themselves at increased risk, Dr. Siris said in an interview. “For example, 64% of women who had already had a fracture thought their risk of future fracture was lower than or the same as another woman of their age.”
Even more surprising, she said, 55% of women who had been told by a physician that they had osteoporosis thought that they were not at increased risk. “There was an obvious disconnect between knowing that they had the disorder and recognizing that it put them at increased risk of a fracture in the future,” she said. Of those with a FRAX index score of 5 or more, 75% also failed to identify themselves as being at high risk.
Women with other risk factors displayed a similar ignorance, Dr. Siris noted. Of women whose mother had experienced a hip fracture, 74% thought they were at a lower fracture risk than their peers or had a similar risk, as did 74% of those with a low body mass index, 80% of current smokers, 77% of those who frequently consumed alcohol, 61% of those taking corticosteroids, and 71% of those with rheumatoid arthritis.
The replies were consistent across countries, she said at an international symposium sponsored by the National Osteoporosis Foundation. “There is apparently a worldwide problem with communicating these ideas to patients.”
The failure to appreciate the implications of fracture risk may help account for the “lousy adherence” to osteoporosis therapy, said Dr. Siris, director of the osteoporosis center at Columbia University, New York. “People may simply just not comprehend the reason they are being treated.”
Patients clearly need more risk counseling from their physicians, she said. “Bone health has to be something we, as doctors, pay constant attention to. And certainly as part of our discussions with patients, we need to collect information on risk factors and convey to patients that these factors do put them at increased risk for a fracture.”
Similarly, she said, those discussions should include information about how to mitigate risk factors. “Patients can take a number of steps to reduce their risk, such as not smoking, not drinking excessively, taking vitamin D and calcium every day, and taking bone-building medication as directed.”
Dr. Siris disclosed that she has receive consulting fees for her time working on GLOW from Sanofi-Aventis and Procter & Gamble Co., which funded the project.