Date: April 1st, 2005
A new national survey reveals too many physicians misread or do not even ask about the fears of their osteoporosis patients and inferentially suggests this may be one more reason why many patients do not stick with their medications.
According to the Women’s Bone Health Survey conducted by the Opinion Research Corporation in collaboration with the Alliance, more than half of the polled women say they take their medications to remain healthy and independent, yet two-thirds of the surveyed doctors believe avoiding bone fractures is the key patient concern.
Why can the differing understandings matter?
“It’s fair to assume that better doctor-patient communication would give physicians a deeper grasp of the emotional catalysts driving women to protect their bones, and by extension, their independence, ” says Daniel Perry, executive director of the Alliance for Aging Research. “If physicians understood their patients better, it’s likely they would have more success in persuading patients to stay on their medications.”
The disease was declared a national health threat in the 2004 Surgeon General’s Report on Bone Health and Osteoporosis. The Women’s Bone Health Survey involved some 750 postmenopausal women diagnosed with the condition and 350 physicians. Though medication is a key part of protecting bones, the latest study finds 70 percent of the doctors regard “poor persistence “ (taking medication for as long as needed) as a problem. Other recent studies report half to almost two-thirds of patients go off medication within a year and that these lapses can increase fractures and healthcare costs.
The survey showed the problem extends further than physicians failing to consider the disease from the patients’ point of view; most doctors and patients say they do not even discuss the condition during every office visit.
“We know some of the reasons for the communication failures,” says Dr. Deborah T. Gold who does research with osteoporosis patients at Duke University Medical Center in Durham, N.C. “Many physicians don’t talk about osteoporosis because they may not feel that it is as serious as patients think it is. Diseases like cancer and hypertension are more urgent.” She also observes that today’s medical environment limits physician-patient interaction. “Patients themselves may feel uncomfortable bringing up topics that aren’t mentioned by their physicians and are not assertive enough in trying to get their questions answered.”
Physicians and patients do agree on some of the other reasons patients don’t stay on bisphosphonate therapy as long as needed. They are concerned about the medication’s side effects, overmedication, coping with other conditions and diseases, and their inability to feel osteoporosis medicines working.
Dr. Gold says the issue of non-compliance is big—and ironic. “Ten years ago, we didn’t have any medications for osteoporosis except two hormones, estrogen and calcitonin; now that we do have them, we need to convince people to take them correctly and continuously.”
“People rarely have trouble taking pain medications because they experience relief—they feel the medicine working,” she continues. “Patients with conditions like osteoporosis and hypertension don’t feel their bone growing strong or their blood pressure going down. They only know medications work when they have a bone density measurement or when they’re examined in the doctor’s office.”
She has a suggestion for better doctor-patient communication and improved persistence rates.
“It’s important to give people a sense of comfort-- and this is hard to do if they are told at first they must take osteoporosis medications for the remainder of their lives. Patients need to be given short-term, more realistic goals. For example, we may be better off saying something like ‘Let’s plan to have you on medication for 18 to 24 months. At that point, we will measure your bone density again and make a decision about future medication. That way, nobody is facing a life sentence on medication.”
Dr. Gold says it is also helpful to engage family members in efforts to keep patients on their medicines. This may be especially true with osteoporosis because it is partly a hereditary disease. “Mothers and daughters can work together on diet, exercise, and medication. They can support each other if one is trying to treat osteoporosis and the other to prevent it.”
The Bone Health Survey was conducted between December 14, 2004 and January 5, 2005 with support and assistance provided by GlaxoSmithKline and Roche. The respondents included 752 females, between 50 and years of age and 352 primary care and OBGYN physicians. To improve the communication process between patients and physicians, the Alliance has developed a free discussion guide for use by patients and physicians during office visits. It offers questions, tips and advice about risks, preventions and treatment. Requests for the guide can be made at www.agingresearch.org.