Current situation of shared decision making in osteoporosis: A comprehensive literature review of patient decision aids and decision drivers

Abstract

Background and Aims Osteoporosis is a systemic skeletal disease characterized by low bone mass and microstructural deterioration of bone tissues, resulting in bone fragility and increased fracture risk. It is the most common bone‐related disease in the population. However, the proportion of patients who start treatment but discontinue it during the first year is very high (around 50%). Endeavors are made to promote patient participation in treatment by implementing patient decision aids (PDA), whose function is to help the patient make disease‐related decisions. We aim to summarize the characteristics of the currently available PDA for osteoporosis, as well as deciding factors. Methods Comprehensive review of the literature. Results Currently, eleven PDAs can be found for osteoporosis. These PDA have different characteristics or options such as information about treatments tailored to patient needs, graphic information of the results (to facilitate understanding), personal histories (learning), tests to check the knowledge acquired, provision of evidence, clinical practice guidelines or a final summary to share with their doctor. Only five of these PDAs can be considered complete since they provide relevant disease information and therapeutic options to the patient, promote patient's reflection and foment patient‐physician discussion. Conclusions This study provides an update on the current state of decision making on osteoporosis and available PDA, which can help engage the patient through shared decision‐making by considering, among other things, patient preferences. Physicians should consider PDA, as it may promote adherence and effectiveness of treatment.

Patients’ preferences for fracture risk communication: the Risk Communication in Osteoporosis (RICO) study

“…In addition, the authors found that the available decision aids did not comprehensively meet international quality standards and patient needs. Later, Nogues et al [ 23 ] reported that only five decision aids in the field of osteoporosis could be deemed to be completely comprehensive, as they effectively deliver pertinent information about the disease and present viable treatment options to patients. Therefore, the development of new tools and new decision aids is crucial for the field of osteoporosis and fracture prevention.…”

Features of bone remodeling and osteoreparation processes in modeling femoral fracture in genetically modified mice with impaired enzymatic regulation of steroid hormone metabolism

“…Osteoporosis is a disease without any pathognomonic clinical signs, which usually remains undiagnosed until a pathological fracture or fracture occurs as a result of lowforce exposure (de Souza 2010; Nogués et al 2022). An osteoporotic fracture, usually affecting the hip and spine, affects a person's performance and normal functioning, leading to chronic pain and long-term rehabilitation (Vidal et al 2019).…”

“…anti-sclerostin antibodies (romozozumab), strontium ranelate and parathyroid hormone analogues (Tabatabaei-Malazy et al 2017;Camacho et al 2020;Nogués et al 2022).…”

Recommendations on screening for primary prevention of fragility fractures

“…Decision aids may improve understanding of potential benefits and harms of preventive treatment 55 – 57 and shared decision-making could better align screening and treatment with patient preferences. 58 – 60 …”

“…Risk assessment–first screening may be acceptable given an increased emphasis on shared decision-making. 60 , 63 , 64 However, access to family physicians and BMD testing varies by age, region (rural and remote v. urban areas), socioeconomic status and race or ethnicity. 65 – 67 In 2015, 11% of Canadian females aged 65–79 years received a BMD.…”