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OSTEOPOROSIS CHOICE Decision Aid

OSTEOPOROSIS CHOICE Decision Aid. Spyridoula Maraka, MD Mayo Clinic. CLINICAL CASE. 67 year-old Caucasian female comes for preventive medicine visit History significant for type 2 diabetes-well controlled on metformin No persona l /family history of fracture

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OSTEOPOROSIS CHOICE Decision Aid

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  1. OSTEOPOROSIS CHOICEDecision 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. CALCULATE RISK

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

  10. BACK TO OUR CASE..

  11. Major Osteoporotic Fracture-10 year risk

  12. Hip Fracture-10 year risk

  13. Intervention

  14. Intervention

  15. Issues

  16. Issues

  17. Issues

  18. Notes

  19. 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? • http://osteoporosisdecisionaid.mayoclinic.org/

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