Barriers and Expectations for Patients in Post-Osteoporotic Fracture Care in France: The EFFEL Study

Published:November 25, 2021DOI:


      • A large gap between real-world care of osteoporotic fractures and practice guidelines has been demonstrated. Although many reasons for this have been proposed, their relative importance is unknown.
      • This study identified potential barriers to care and expectations for care in individuals who had experienced osteoporotic fractures using a qualitative approach and then went on to rank these barriers and expectations in terms of importance to the patient using a best-worst scaling approach. This allowed the most important barriers to better care of patients with osteoporotic fractures to be identified.
      • The 2 most important barriers are a lack of patient information about osteoporosis and inadequate coordination of care. Strategies to overcome these barriers are proposed. Different patient groups have different perceptions and expectations and these need to be taken into account when implementing these strategies.



      This study aimed to quantify the relative importance of barriers to better secondary prevention of osteoporotic fractures and of care expectations expressed by patients with osteoporotic fractures in France.


      A qualitative exploration of potential barriers to care and expectations was undertaken through a systematic literature review and in-depth patients interviews. A list of 21 barriers and 21 expectations was identified. These were presented to 324 subjects with osteoporotic fractures, identified in a representative sample of the French population, in the form of best-worst scaling questionnaires. Patients rated the relative importance of the attributes, and arithmetic mean importance scores were calculated and ranked. A Bayesian hierarchical model was also performed to generate a relative importance score. Latent class analysis was performed to identify potential subgroups of patients with different response profiles.


      A total of 7 barriers were rated as the most important, relating to awareness of osteoporosis and coordination of care. The highest-ranked barrier, “my fracture is not related to osteoporosis,” was significantly more important than all the others (mean importance score 0.45; 95% confidence interval 0.33-0.56). A similar ranking of attributes was obtained with both the arithmetic and the Bayesian approach. For expectations, no clear hierarchy of attributes was identified. Latent class analysis discriminated 3 classes of respondents with significant differences in response profiles (the educated environmentalists, the unaware, and the victims of the system).


      Better quality of care of osteoporosis and effective secondary fracture prevention will require improvements in patient education, training of healthcare professionals, and coordination of care.


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