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. 2020 Jul;31(7):1283-1290.
doi: 10.1007/s00198-020-05312-4. Epub 2020 Feb 4.

Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment

G Adami  1   2 , K G Saag  1 , A S Mudano  1 , E J Rahn  1 , N C Wright  1 , R C Outman  1 , S L Greenspan  3 , A Z LaCroix  4   5 , J W Nieves  6 , S L Silverman  7 , E S Siris  8 , N B Watts  9 , M J Miller  10   11 , S Ladores  1 , J R Curtis  1 , M I Danila  12
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Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment

G Adami et al. Osteoporos Int. 2020 Jul.

Abstract

We investigated the factors associated with readiness for initiating osteoporosis treatment in women at high risk of fracture. We found that women in the contemplative stage were more likely to report previously being told having osteoporosis or osteopenia, acknowledge concern about osteoporosis, and disclose prior osteoporosis treatment.

Introduction: Understanding factors associated with reaching the contemplative stage of readiness to initiate osteoporosis treatment may inform the design of behavioral interventions to improve osteoporosis treatment uptake in women at high risk for fracture.

Methods: We measured readiness to initiate osteoporosis treatment using a modified form of the Weinstein Precaution Adoption Process Model (PAPM) among 2684 women at high risk of fracture from the Activating Patients at Risk for OsteoPOroSis (APROPOS) clinical trial. Pre-contemplative participants were those who self-classified in the unaware and unengaged stages of PAPM (stages 1 and 2). Contemplative participants were those in the undecided, decided not to act, or decided to act stages of PAPM (stages 3, 4, and 5). Using multivariable logistic regression, we evaluated participant characteristics associated with levels of readiness to initiate osteoporosis treatment.

Results: Overall, 24% (N = 412) self-classified in the contemplative stage of readiness to initiate osteoporosis treatment. After adjusting for age, race, education, health literacy, and major osteoporotic fracture in the past 12 months, contemplative women were more likely to report previously being told they had osteoporosis or osteopenia (adjusted odds ratio [aOR] (95% CI) 11.8 (7.8-17.9) and 3.8 (2.5-5.6), respectively), acknowledge concern about osteoporosis (aOR 3.5 (2.5-4.9)), and disclose prior osteoporosis treatment (aOR 4.5 (3.3-6.3)) than women who self-classified as pre-contemplative.

Conclusions: For women at high risk for future fractures, ensuring women's recognition of their diagnosis of osteoporosis/osteopenia and addressing their concerns about osteoporosis are critical components to consider when attempting to influence stage of behavior transitions in osteoporosis treatment.

Keywords: Behavioral changes; Fracture; Osteoporosis; Precaution Adoption Process Model.

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Conflict of interest statement

Conflict of Interest

Giovanni Adami, Amy S. Mudano, Elizabeth J. Rahn, Ryan C. Outman, Susan L. Greenspan, Andrea Z. LaCroix, Jeri W. Nieves, Ethel S. Siris, Michael J. Miller, Sigrid Ladores, Maria I. Danila declare that they have no conflict of interest related to the present manuscript. The following authors declare the following conflicts of interest. Kenneth G. Saag - Amgen, Gilead, Radius (Consultant), Amgen (Research Grant); Nicole C. Wright - Amgen (Grants), Pfizer/Norton Rose/Fulbright (Expert Witness); Stuart L. Silverman- Radius, Amgen, Lilly (Speaker), Amgen (Grants), Amgen, Radius, Lilly (Advisory Board member); Nelson B. Watts - Amgen (Consultant, Speaker), Radius (Speaker); Jeffrey R. Curtis - Amgen/Radius (Consultant, Teaching);

Figures

Figure 1.
Figure 1.
Multi-step process in osteoporosis treatment initiation illustrated using the Precaution Adoption Process Model (PAPM) stages of decision making.* *PAPM stage 7 (maintenance stage) is not included in the figure
See this image and copyright information in PMC

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