Original article| Volume 24, ISSUE 1, e69-e75, January 2014

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Fracture Risk Perception Study: Patient Self-Perceptions of Bone Health Often Disagree with Calculated Fracture Risk



      We sought to evaluate the concordance between self-assessed perceptions of fracture risk and actual risk calculated by World Health Organization's 10-year Fracture Risk Assessment Tool (FRAX).


      We collected demographic data, lifestyle information, osteoporosis knowledge, bone density test results, and treatment history from patients aged 50 to 75 years. Subjects rated their perceptions of 10-year risk of sustaining fracture as low (0%–9%), intermediate (10%–19%), or high (≥20%). This rating was compared with risk calculated by FRAX.


      Among 426 patients, the greatest agreement regarding fracture risk was noted for those in the low-risk FRAX group: 81% perceived themselves as having low risk. The most risk disagreement was in the high-risk FRAX group: Only 18% perceived their risk as high. Perceived risk was intermediate for 59% and low for 24%. Of patients at intermediate calculated risk by FRAX, 48% agreed with this with self-perceived risk. Overall, risk agreement was associated with bone density results, with higher T scores predictive of agreement. Underestimation was associated with being female and older. Patients with prescription treatment exposure frequently had risk disagreement and perceived their risk as lower than their calculated FRAX scores might indicate. Patients taking calcium and vitamin D similarly perceived lower risk than calculated by FRAX.


      Patients at intermediate and high calculated fracture risk frequently had self-perceptions of lower risk. Patients taking prescription osteoporosis medication and calcium and vitamin D treatment perceived less risk than calculated. Whether correcting misperceptions about personal susceptibility to fracture might result in behavioral changes will be determined.
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      Dr. Grover is an Assistant Professor of Family Medicine and a Research Scholar of the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. His research interests include cost conscious care and guideline adherence.


      Dr. Edwards is an Assistant Professor and Chairman of Family Medicine. He has research interests in assessing tools to improve physicians' clinical productivity and their communication with patients.


      Dr. Chang is a Biostatistician and Research Associate in the Division of Biostatistics, Department of Health Services Research. She advises and collaborates with investigators in research protocol design as well as performing statistical analyses and assisting in manuscript preparation.


      Dr. Cook is Professor of Medicine and Chair, Division of Endocrinology. An author of over 100 manuscripts, he actively mentors junior investigators while continuing an active research program which includes advancing inpatient diabetes management.


      Dr. Behrens is an Assistant Professor of Family Medicine and holds a Certificate of Added Qualifications in Geriatric Medicine. She is active in the American Medical Directors Association and leads medical student educational activities for the Department.


      Dr. Dueck is a Senior Associate Consultant and Assistant Professor of Biostatistics. She collaborates frequently with investigators in the Mayo Clinic Cancer Center while providing insights into study design, data analyses and manuscript preparation.