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Preference for Hip Protectors Among Older Adults at High Risk for Osteoporotic Fractures
LIANA FRAENKEL, BARBARA GULANSKI, and DICK R. WITTINK ABSTRACT. Objective. To determine older adults' treatment preferences for osteoporosis comparing bisphosphonates and hip protectors. Methods. Subjects at high risk for an osteoporotic hip fracture completed a discrete choice questionnaire to determine preferences for hip protectors versus oral weekly bisphosphonates. Simulations, based on respondents' values for type of treatment and absolute reduction in risk of hip fractures over 5 years, were performed to predict treatment choices. Results. Seventy-six patients participated in this study (92% participation rate). At the time of the study 57% of the participants were currently using bisphosphonates; none had ever heard of a hip protector. In the base-case scenario, in which both options were described as being equally effective, 9% preferred hip protectors, 88% weekly oral bisphosphonates, and 3% refused all options. When hip protectors were described as being more effective than bisphosphonates, 26% preferred hip protectors, 71% weekly oral bisphosphonates, and 3% continued to refuse all options. Preference for hip protectors was stronger among participants not currently using bisphosphonates (36% vs 19%, p = 0.08), as well as among subjects preferring to avoid taking prescription drugs for most health problems (44% vs 12%, p = 0.002). Conclusion. When presented with tradeoffs between hip protectors and bisphosphonates, the majority of community-dwelling older adults at high risk for fracture prefer the latter. Of note, however, many of the participants in this study were current bisphosphonate users. Future trials and education programs should consider targeting respondents preferring to manage health problems using nonpharmacologic treatment approaches since, based on the results of this study, adherence and proper use of hip protectors is expected to be higher among these patients. (J Rheumatol 2006;33:2064-8) Key Indexing Terms:
OSTEOPOROSIS From the Veterans Administration Connecticut Healthcare System and the Yale University School of Medicine, New Haven, Connecticut, USA. Supported by the Arthritis Foundation Clinical Science Grant. Dr. Fraenkel is also supported by the K23 Award AR048826-01 A1. L. Fraenkel, MD, MPH, Associate Professor of Medicine; B. Gulanski, MD, MPH, Assistant Professor of Medicine, VA Connecticut Healthcare System and Yale University School of Medicine; D.R. Wittink, PhD, George Rogers Clark Professor of Management and Marketing. Dr. Wittink is deceased. Address reprint requests to Dr. L. Fraenkel, Yale University School of Medicine, Section of Rheumatology, 300 Cedar St., TAC 525, PO Box 208031, New Haven, CT 06520-8031, USA. E-mail: liana.fraenkel@yale.edu Accepted for publication May 25, 2006.
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