Randomised trial assessing the impact of framing of fracture risk and osteoporosis treatment benefits in patients undergoing bone densitometry

BMJ Open. 2017 Feb 10;7(2):e013703. doi: 10.1136/bmjopen-2016-013703.


Objectives: The accuracy of patients' perception of risk is important for decisions about treatment in many diseases. We framed the risk of fracture and benefits of treatment in different ways and assessed the impact on patients' perception of fracture risk and intentions to take medication.

Design: Randomised trial of 4 different presentations of fracture risk and likely benefits from osteoporosis treatment.

Setting: Academic centre.

Participants: 200 patients undergoing bone densitometry.

Intervention: Presentation that framed the patient's absolute fracture risk either as the chance of having or not having an event, with their likely benefits from osteoporosis treatment in natural frequencies or numbers needed to treat.

Outcomes: Participants' views about their fracture risk and the need for osteoporosis treatment.

Results: The median 5-year fracture risk threshold participants regarded as high enough to consider preventative medication was 50-60%, and did not change substantially after the presentation. The median (Q1, Q3) 5-year risk initially estimated by participants was 20% (10, 50) for any fracture and 19% (10, 40) for hip fracture. 61% considered their fracture risk was low or very low, and 59-67% considered their fracture risk was lower than average. These participant estimates were 2-3 times higher than Garvan calculator estimates for any fracture, and 10-20 times higher for hip fracture. Participant estimates of fracture risk halved after the presentation, but remained higher than the Garvan estimates (1.5-2 times for any fracture, 5-10 times for hip fracture). There was no difference in these outcomes between the randomised groups. Participants' intentions about taking medication to prevent fractures were not substantially affected by receiving information about fracture risk and treatment benefits.

Conclusions: Altering the framing of estimated fracture risks and treatment benefits had little effect on participants' perception of the need to take treatment or their individual fracture risk.

Trial registration number: ACTRN12613001081707; Pre-results.

Keywords: Communication; Fracture; Medication; Osteoporosis; Risk.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Aged
  • Attitude to Health*
  • Bone Density Conservation Agents / therapeutic use*
  • Bone Density*
  • Female
  • Hip Fractures / prevention & control*
  • Humans
  • Intention
  • Male
  • Medication Adherence
  • Middle Aged
  • Osteoporosis / diagnostic imaging
  • Osteoporosis / drug therapy*
  • Osteoporotic Fractures / prevention & control*
  • Patient Education as Topic
  • Perception*
  • Risk


  • Bone Density Conservation Agents

Associated data

  • ANZCTR/ACTRN12613001081707