Women's Perceptions of Future Risk After Low-Energy Fractures at Midlife

Abstract

PURPOSE Low-energy fractures experienced by women at midlife and beyond place them at increased risk of future fractures and may be early indicators of low bone density. We report here on women's postfracture narratives to provide insight into how family physicians might tailor their messages to patients in communicating risk.METHODS An interview guide was used in face-to-face interviews with women aged 40 years and older. Patients were asked to describe their fracture experience and recovery during the subsequent year. Interviews were audiorecorded and transcribed verbatim. Analysis was done initially using an immersion-crystallization approach.RESULTS Twenty-two women participated in this research. The analysis showed women's reactions to information about their risk fell into 3 groups. The fi rst took a laissez faire approach, preferring to wait and see what the future held. The second group recognized some of the things they should be doing but were inconsistent in maintaining changes or seeking relevant information. The third group saw information about future risk as salient and important to their daily lives. They actively sought out information, including discussions with their family physicians.CONCLUSIONS Discovering whether patients have had an injury and, if so, how they perceive future risk is important because the invisibility of this health hazard calls for vigilance early on in women's lives. Family physicians can help patients move from perceiving the fractures as isolated accidents to understanding them as indicators of future risk by discussing the importance of bone health in the short and long term. INTRODUCTIONU ntil recently the focus on bone health for women tended to be on osteoporosis, a condition of established chronic disease and a source of considerable public health cost. [1][2][3][4][5][6][7][8] In Canada, 1 in 4 women and 1 in 8 men aged 50 years and older have osteoporosis.9 The risk of low-energy fractures is substantial: at a population level women have a 1 in 6 lifetime risk of hip fractures, as compared with a 1 in 9 risk of developing breast cancer.2,10,11 Recent research in Canada projects an annual total cost for femoral fractures alone (about three quarters occurring in women) at $10 billion, rising to $20 billion if osteoporotic fractures are included.12 Aside from economic costs, the "quality of life impact of hip, wrist and vertebral fractures" is often overlooked.5 Earlier research by our team has shown that the short-and long-term sequelae of extremity fractures, including time off work, the need for support for activities of daily living, and permanent loss of function and disfi gurement, 13 are great, even in the absence of established disease.Prevention, early detection, and cost-effective treatment are possible and recommended to save pain, suffering, and health care costs of osteoporosis and related fractures. 14 Currently the role of family physicians in relation to fragility fracture prevention is hampered by 2 factors. First, there is inconsistent tr...

Perceived Vulnerability to Heart Disease in Patients with Familial Hypercholesterolemia: A Qualitative Interview Study

“…1 A strong predictor of patients' readiness for medical treatment and preventive behavior is their perceived vulnerability to disease. [2][3][4][5][6] The family history forms a basis upon which a person assesses his or her own vulnerability to common chronic diseases, 7,8 and the family history is becoming increasingly important as a medical devise to predict risk of future disease.…”

A review of patient-centred post-fracture interventions in the context of theories of health behaviour change

“…Aiming a post-fracture intervention at such patients fits the Teachable Moment framework because this framework emphasizes the importance of using a strong emotional response to a cueing event in building a 'teachable moment' and motivating subsequent behaviour change. Teachable Moment was previously mentioned in the context of post-fracture care by two authors [12,81]: One suggested that fractures were excellent teachable moments to educate patients about the importance of osteoporosis care while the other concluded that many patients have misperceptions about their osteoporosis and fracture risks and that physicians can use fractures as teachable moments to deliver health information and, more importantly, make this information relevant for patients.…”

“…Theoretical frameworks previously suggested in the context of osteoporosis management [12,81] should be tested. More research identifying intervention gaps from the patient's perspective should also be conducted.…”

“…Barriers to more effective osteoporosis management are well documented and associated with both the patient and the healthcare environment. Patient-related barriers include a lack of knowledge of osteoporosis and consequences of fractures, as well as the perception that treatment is ineffective and that fracture healing is the end of the health concern [11,12]. It is therefore not surprising that many patients are reluctant to undergo further testing and treatment and that the rate of treatment initiation and subsequent compliance remain suboptimal [10,13].…”

In This Issue

“…10 The authors identify 3 belief systems among women in this study, which seem to call for different clinical approaches to individualizing care.…”