After the Fall: Women's Views of Fractures in Relation to Bone Health at Midlife

Abstract

Past research has established the link between low energy fractures and the risk for future fractures. These fractures are potential markers for investigation of bone health, and may be precursors for osteoporosis. In spite of its significant public health burden, including burden of illness and economic costs, many individuals are not aware of the risk factors for and consequences of osteoporosis. This is a study of women aged 40 and older who experienced low energy fractures (e.g., from non-trauma sources and falls from no higher than standing height). We gathered data, using focus group interviews, about their experiences and understanding of the fractures in relation to bone health. Women often attributed the fractures to particular situations and external events (e.g., slipping on ice, tripping on uneven ground), and viewed the fractures as accidents. Women often felt that others are at risk for poor bone health, but believed that they themselves are different from those really at risk. Although the fractures are potential triggers for preventive efforts, few women connected their fracture to future risk. What is perceived by women (and others) as random and an accident is often a predictable event if underlying risk factors are identified. Only when there is more awareness of poor bone health as a disease process and fractures as markers for bone fragility will women, men and health care providers take action to prevent future fractures and established bone disease.

Osteoporosis risk perceptions among patients who have sustained a fragility fracture

“…Previous reports of patient perceptions of fracture support our finding that individuals who suffer fragility fractures attribute their fractures to external causes rather than to bone fragility [10,11]. In fact, for some patients the belief that their fracture was an accident was so strong that even subsequent fractures were attributed to external situations rather than bone fragility [10,11]. Patients' beliefs about cause and effect was a cross-cutting theme; factors such as bone density, the presence of osteoporosis risk factors and being careful were perceived as potential "causes" of fracture, and perceptions about personal fracture risk appeared to be defined by the presence or absence of these factors.…”

“…This finding is of great concern given that all of the respondents had a fragility fracture, which is an independent risk factor for future fractures [6]. Previous reports of patient perceptions of fracture support our finding that individuals who suffer fragility fractures attribute their fractures to external causes rather than to bone fragility [10,11]. In fact, for some patients the belief that their fracture was an accident was so strong that even subsequent fractures were attributed to external situations rather than bone fragility [10,11].…”

“…In-depth interviews reveal that many patients with fragility fracture had not associated their fracture with bone fragility. Instead they attributed their fractures to external factors, such as a fall, or slipping on ice [10][11][12]. With a chronic disease such as osteoporosis, patient self-management is an important element in effective long-term management, especially with self-care issues such as adequate calcium and vitamin D intakes, fall prevention and exercise [13].…”

“…Although previous studies have evaluated osteoporosis risk perceptions among peri-and postmenopausal women, it is not known whether patients with fragility fracture understand that they are at increased risk of future fracture, regardless of whether they have osteoporosis based a on bone mineral density test [10,11,16]. Further, no study has specifically explored the perspectives of fragility fracture patients who do and do not perceive themselves to be at risk of fracture, and the beliefs underlying those perceptions.…”

A Cultural Models Approach to Osteoporosis Prevention and Treatment

“…In a qualitative study conducted in Scotland, Backett-Milburn, Parry, and Mauthner (2000) were surprised to find that only a minority of the women in their study, aged 40 to 55 years, mentioned osteoporosis without prompting, and when they did so there was little interest in osteoporosis as a health concern (Backett-Milburn et al, 2000). Similar findings were indicated by Meadows and colleagues in Canada (Meadows, Mrkonjic, & Lagendyk, 2005;Meadows, Mrkonjic, Petersen, & Lagendyk, 2004), and Reventlow and Bang (2006) in Denmark, where women's views of osteoporosis were found to be influenced by stereotypes of aging and inevitable bodily decay.…”