Women's Values and Preferences Regarding Osteoporosis Treatments: A Systematic Review.
J Clin Endocrinol Metab. 2019 Mar 25;: Authors: Barrionuevo P, Gionfriddo MR, Castaneda-Guarderas A, Zeballos-Palacios C, Bora P, Mohammed K, Benkhadra K, Sarigianni M, Murad MH
BACKGROUND: Several treatments are available to reduce the risk of fragility fractures associated with osteoporosis. The choice of treatment requires knowledge of patients' values and preferences. The aim of this study was to summarize what is known about values and preferences relevant to the management of osteoporosis in women. METHODS: We conducted a comprehensive search of several databases for studies published in any language including women who had already started or about to start any pharmacological therapy for osteoporosis. Pairs of reviewers independently selected studies and extracted data. The results were synthesized narratively. RESULTS: We included 26 studies reporting on 15,348 women (mean age 66 years). Women in general considered effectiveness and adverse events equally, followed by the convenience of taking the drug and impact on daily routine (less frequent dosing was preferred, oral route was preferred, injectable route was preferred over oral if given less frequently). Cost and duration of treatment were less important factors for decision making. Fear of breast cancer and fear of resuming uterine bleeding were common reasons for not choosing estrogen therapy. Calcium and vitamin D were viewed as safe and natural. Across studies, preferences were not affected by age, previous drug exposure or employment status. CONCLUSIONS: Women starting osteoporosis medications value effectiveness and side effects equally and prefer medications given less frequently. Injectable drugs appear to be acceptable as long as they are given less frequently. More research on patient values and preferences is needed to guide decision making in osteoporosis. PMID: 30907968 [PubMed - as supplied by publisher]