A randomized study of the effect of five-year and lifetime hip fracture risk information on physician recommendations for management of low bone density

摘要

While risk prediction tools providing absolute fracture risk information are currently under development, little is known about U.S. physicians’ current thresholds for osteoporosis treatment or the potential effect of fracture risk information upon treatment decisions. To investigate this, a random sample of U.S. primary care physicians was surveyed. Treatment recommendations for four patient scenarios depicting postmenopausal women of varying ages, weights and BMD were elicited. Physicians were randomly assigned to receive all scenarios with either a basic BMD report or an augmented BMD report containing five-year and lifetime absolute hip fracture risk estimates. Over 95% of physicians recommended prescription pharmacologic treatment of a seventy year-old patient with osteoporosis. For three scenarios depicting women with T-scores of −1.01, treatment recommendations ranged from 30 to 44%. There were no statistically significant differences between physicians who received augmented and basic BMD reports, although those with augmented BMD reports were less likely to recommend prescription treatments. Physician specialty had inconsistent and small effects on recommendations. We conclude that nearly all of a random sample of US primary care physicians recommend pharmacologic treatment of osteoporosis, but a substantial minority also recommend treatment for patients who would not fit current guidelines. A BMD report including absolute hip fracture risk estimates did not change treatment recommendations.