Preference for hip protectors among older adults at high risk for osteoporotic fractures

Objective. To determine older adults' treatment preferences for osteoporosis comparing bisphosphonates and hip protectors. Methods. Subjects at high risk for an osteoporotic hip fracture completed a discrete choice questionnaire to determine preferences for hip protectors versus oral weekly bisphosphonates. Simulations, based on respondents' values for type of treatment and absolute reduction in risk of hip fractures over 5 years, were performed to predict treatment choices. Results. Seventy-six patients participated in this study (92% participation rate). At the time of the study 57% of the participants were currently using bisphosphonates; none had ever heard of a hip protector. In the base-case scenario, in which both options were described as being equally effective, 9% preferred hip protectors, 88% weekly oral bisphosphonates, and 3% refused all options. When hip protectors were described as being more effective than bisphosphonates, 26% preferred hip protectors, 71% weekly oral bisphosphonates, and 3% continued to refuse all options. Preference for hip protectors was stronger among participants not currently using bisphosphonates (36% vs 19%, p = 0.08), as well as among subjects preferring to avoid taking prescription drugs for most health problems (44% vs 12%, p = 0.002). Conclusion. When presented with tradeoffs between hip protectors and bisphosphonates, the majority of community-dwelling older adults at high risk for fracture prefer the latter. Of note, however, many of the participants in this study were current bisphosphonate users. Future trials and education programs should consider targeting respondents preferring to manage health problems using nonpharmacologic treatment approaches since, based on the results of this study, adherence and proper use of hip protectors is expected to be higher among these patients.