1. OSTEOPOROSIS CHOICE Decision Aid
Spyridoula Maraka, MD
Mayo Clinic

2. 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

3. 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

5. 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

6. 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

8. 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

9. 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

11. CALCULATE RISK

12. Type 1 diabetes, premature menopause, chronic malabsorption, hyperthyroidism, hypogonadism

13. BACK TO OUR CASE..

14. Major Osteoporotic Fracture-10 year risk

15. Hip Fracture-10 year risk

16. Intervention

17. Intervention

18. Issues

19. Issues

20. Issues

21. Notes

22. 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?