osteoporosis choice decision aid spyridoula maraka, md mayo clinic mayo clinic
TRANSCRIPT
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OSTEOPOROSIS CHOICEDecision Aid
Spyridoula Maraka, MD
Mayo Clinic
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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
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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
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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
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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
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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
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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
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CALCULATE RISK
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Type 1 diabetes, premature
menopause, chronic
malabsorption, hyperthyroidis
m, hypogonadism
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BACK TO OUR CASE..
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Major Osteoporotic Fracture-10 year risk
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Hip Fracture-10 year risk
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Intervention
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Intervention
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Issues
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Issues
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Issues
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Notes
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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/