Ipsos Health. How Fragile Is Her Future? Research Germany

Transcription

1 ISO9000 How Fragile Is Her Future? Research Germany Prepared for the International Osteoporosis Foundation and Sponsored by an educational grant from Lilly 1 Ipsos-RSL

2 Research Methodology 2 Computer-Aided-Telephone-Interiews conducted amongst GPs and postmenopausal women in each of the following countries: U.K., France, Germany, Italy, Spain, Canada, Australia, Jordan, Mexico, Brazil, Lebanon (Face to face interiews conducted in Middle East and Mexico) 100 interiews conducted amongst GPs and 50 amongst postmenopausal women GP sample purchased by pharmaceutical list leasing proiders Consumer sample ia random digit dialling and identified through screening questions In each country 5 pilot interiews conducted amongst GPs and necessary changes made to final questionnaire GPs paid an incentie of 15. No incenties offered to consumers Fieldwork dates for GPs: 3rd - 28th April Fieldwork dates for consumers: 6th March - 4th April

3 ISO9000 Main Findings 3 Ipsos-RSL

4 ISO9000 German Consumers 4 Ipsos-RSL

5 Q.2 Age of respondents 10% 12% 12% 21% Mean: 60 years 15% 8% 23% Base: All female respondents aged 41+ and been through menopause (n=52)

6 Q.4 Whether suffer from osteoporosis No 65% DK 10% Yes 25% 6 Base: All female respondents aged 41+ and been through menopause (n=52)

7 Q.5 Number times isited GP in last 12 months 29% Mean: 7.6 times s. 6.5 times across all countries 8% 10% 8% 21% 25% to 5 6 to Base: All female respondents aged 41+ and been through menopause (n=52)

8 8 Base: All female respondents aged 41+ and been through menopause (n=52) Q.6 Key health concerns (spont) None 27% CNS Diabetes Arthritis/joints Cancer (nsf) 4% 4% 4% 4% Other health concerns mentioned on indiidual basis Osteoporosis mentioned by 27% of women across all countries Heart/CV 31% Bone/osteoporosis 38%

9 9 Base: All female respondents who currently hae health concerns (n=38) Q.7 Main health concern CNS Heart/CV 5% Osteoporosis was mentioned by 21% of women across all countries 32% Bone/osteoporosis 37%

10 Q.8 Current actiities to improe/ maintain long-term health Nothing Take Medication Holidays Take o/p med Use Vitamin C Take itamins Take calc supp 4% 4% 6% 13% 15% 23% 27% In total 22% of women said they used treatment/ supplements or medication Exercise 42% Drink lots water 44% Eat Healthily 65% 10 Base: All female respondents aged 41+ and been through menopause (n=52)

11 Q.9 Diseases screened for oer last 5 years None Joint Disease RA Thyroid Osteoporosis Cancer (unspec) 8% 4% 4% 6% In total 16% had been screened for cancer Higher mentions of osteoporosis in Germ cf other countries (20% across all countries) 42% 46% Heart disease 48% High cholesterol 50% Breast Cancer 58% 11 Base: All female respondents aged 41+ and been through menopause (n=52)

12 Osteoporosis Screening Q.10 Whether been screened for osteoporosis No 74% DK 3% Yes 23% Q.11 Reasons for being screened for osteoporosis Base: 29 Asked Dr to be screened 8 At risk as post-menopause 5 Suffered a fracture (unspec.) 4 Suffered loss of height 3 Family history of o/p 2 Preentatie check-ups 3 In pain 2 Suffered ertebral frac Base: Respondents who do not spontaneously mention they hae been screened for osteoporosis (n=30) Others reasons mentioned by indiidual respondents

13 Q.12 Awareness of Osteoporosis Screening Programme Yes No 26% Across all countries 35% of women were aware of the programme 70% DK 4% 13 Base: Respondents who hae not been screened for osteoporosis (n=23)

14 14 Q.13 Long-term health risks associated with osteoporosis (prompted) Base: Postmenopausal women aged Increased risk of further fractures 75% Reduced quality of life 67% Long term pain 65% Loss of height 63% Fear of the next fracture/fall 62% Inability to lie an independent life 25% Loss of self-esteem 17% None of the aboe 4%

15 Q.14 Proportion suspected osteoporosis prior to diagnosis Yes No 6 6 DK 1 15 Base: Osteoporosis sufferers (n=13)

16 16 Q.15a Impact osteoporosis has had on quality of life Base: Osteoporosis sufferers 13 Lie in fear of breaking a bone 9 Back pain 9 Cannot lift heay weights 5 I worry about the future 5 Cannot pick up grandchildren 4 Can t go for long walks 3 Reduced actiities with family and friends 3 Cannot participate in sport 2 Less able to get from place to place 2 Other responses mentioned by indiidual respondents

17 Q.15b Whether suffered from a fracture caused by osteoporosis Yes No 6 6 DK 1 17 Base: Osteoporosis sufferers (n=13)

18 Q.15c Length of time taken to recoer from fracture weeks 4-7 weeks 2-5 months 6 months- 1 year Still not recoered 18 Base: Respondents suffered from fracture caused by osteoporosis (n=6)

19 Q.16 Whether aware at risk from osteoporosis prior to diagnosis No 10 Yes 3 19 Base: Osteoporosis sufferers (n=13)

20 Q.17a Precautions would hae taken if knew were at risk Exercise Lifestyle changes Vitamins Calc. supp 6 Medication for preention 8 20 Base: Osteoporosis sufferers unaware at risk of osteoporosis (n=10)

21 Q.17b One thing sufferers would tell other women about osteoporosis Vitamin C Exercise Take o/p med Drink lots of H2O Screened for o/p Take pre. med early 8 Take Ca Suppl Base: Osteoporosis sufferers (n=13)

22 Q.18 Likelihood of deeloping osteoporosis Very likely Fairly likely Not ery likely 0% 5% Mean: 1.8 s. aerage of 2.3 across all countries Very likely +4 Not at all likely +1 59% Not at all likely 26% Don't know 10% 22 Base: Non-osteoporosis sufferers (n=39)

23 23 Base: All female respondents aged 41+ and been through menopause (n=52) Q.19 Degree of concern about long-term health risks of osteoporosis Very concerned Fairly concerned Not ery concerned Not at all concerned 6% 15% Mean: 1.8 s. aerage of 2.5 across all countries Very concerned +4 Not at all concerned +1 As one would expect higher concern amongst sufferers (3.1 s. 1.5) 35% 42% Don't know 2%

24 Whether discussed osteoporosis with doctor 24 Q.20 Whether discussed osteoporosis with doctor No 44% Yes 56% On aerage across all countries 44% of women had discussed o/p with their doctor Base: All female respondents aged 41+ who hae been through the menopause Q.21 Reasons for discussing osteoporosis with a doctor Base 29 Read/heard about o/p 11 Doctor initiated discussion * 7 Swollen knees/joints 4 Dr. init as finished menop. *

25 Whether discussed long-term health risks osteoporosis with doctor Q.22 Whether discussed longterm health risks of osteoporosis with doctor No 41% Q.23 Reasons for not discussing long-term health risks of osteoporosis with a doctor Base 12 Doctor didn t raise it 3 Neer thought about it 2 Lack of time with doctor 1 Frag. bones is sign of ageing 1 Don t know 5 Yes 59% 25 Base: Respondents who hae discussed osteoporosis with their doctor (n=29)

26 Q.24 Extent of agreement that osteoporosis can be preented Strongly agree Tend to agree Tend to disagree Strongly disagree 2% 15% 15% Mean: 3.0 Strongly agree +4 Strongly disagree +1 63% No difference in agreement between sufferers s. non Don't know 4% 26 Base: All female respondents aged 41+ and been through menopause (n=52)

27 Q.25 Best ways of preenting osteoporosis Base: Respondents who agree osteoporosis can be preented 41 Calcium supplements 83% Healthy diet 39% HRT 34% Using specific osteoporosis treatment 29% Vitamin D 27% Using SERMs 10% Vitamins 5% Using bisphosphonates 5% 27 Other ways mentioned by indiidual respondents

28 28 Base: Respondents who hae discussed osteoporosis with their doctor (n=29) Q.26 Therapy options doctor has discussed in relation to osteoporosis DK None Bisphosphanates SERMs HRT 14% 14% 17% 24% 28% Rec. Lifestyle measures 31% Calcium supplements 48%

29 Q.27 Whether currently taking medication for osteoporosis/hormonal problems 66% 21% 15% 2% 29 Treatment of hormones Treatment of o/p Preention of o/p Nothing Base: All female respondents aged 41+ and been through menopause (n=52)

30 30 Base: O/p sufferers not on medication (n=5) Q.28 Reasons o/p sufferers not on medication DK Don't want to start bleeding Inconenient to take Don't want medication 1 Dr. not Rxed anything 1

31 Attitude towards long-term preentatie therapy for osteoporosis Q.29 Whether consider taking long-term preention therapy for osteoporosis on dr. recommendation No 4% DK 16% Q.30 Concerns that would stop women taking long-term preention therapy Base: Respondents not on longterm preention 51 Side effects 24% Don t want to take med l/t 31 Yes 80% Base: Respondents not taking long-term preention of osteoporosis (n=51) 14% Inconenience of taking therapy 8% If didn t work

32 Q.31 Products eer used for the preention/treatment of osteoporosis Estracombi Calc/Mag Prempak Estraderm Didronel 4% 4% 4% 4% 6% Indiidual mentions of Fosamax, Klioance, and Premique HRT 8% DK/NA 54% 32 Base: All female respondents aged 41+ and been through menopause (n=52)

33 Q.32 Products currently using for the preention/treatment of osteoporosis HRT Estracombi Didronel 8% 8% 17% Indiidual mentions of Estraderm, Fosamax, Klioance, and Prempak Ca/Mg 8% DK/NA 4% 33 Base: Respondents who hae eer taken therapy for osteoporosis (n=24)

34 34 Q.33 Agreement with statements Base: Postmenopausal women aged Osteoporosis should be iewed as a serious condition 96% It is ery important to effectiely preent spinal fractures 87% It is ery important to effectiely preent osteoporosis 83% If I had a ertebral fracture I am sure I would know about it 81% Doctors generally hae enough resources to effectiely manage osteoporosis in this country 71% I would like to be/wish I had been screened for o/p 67% If you can preent or treat ertebral/spinal fractures you can preent hip fractures 65% A medicine that can treat a disease is generally more effectie than one that can just preent it 60%

35 35 Q.33 Agreement with statements Base: Postmenopausal women aged Osteoporosis is not a life-threatening condition 56% I feel I hae enough info and knowledge on osteoporosis 56% I am concerned about the l/t risk to my health of taking HRT 54% Getting fragile/brittle bones is ineitable part ageing process 40% Doctors in this country do not seem to take o/p seriously 38% I wish I had taken medication earlier to preent osteoporosis 29%

36 ISO9000 Summary 36 Ipsos-RSL

37 37 Summary The aerage age of the women taking part in the surey was 60, of whom 25% were suffering from osteoporosis On aerage the women had isited their GP <8 times in the last year The women s health concerns were osteoporosis (>third) and heart disease (<third). >quarter of women claimed to hae no health concerns women in Germany appear to be more concerned re. osteoporosis than the aerage across all sureys (38% s. 27%) The one main health concern that the women had was gain osteoporosis (37% s. 21% across all countries)

38 38 Summary Two-thirds of women said that they ate healthily to improe or maintain long term health. <half said they drink lots of water, with a similar number taking exercise Only a fifth of women said they used treatment/supplements/medication to improe or maintain long term health 58% of the women said they had been screened for osteoporosis - much higher than that reported across all countries (34%) The majority of women said they asked the doctor to be screened with no mentions of being recommended to by their doctor

39 Summary 39 Of those who had not been screened a quarter were aware that there was a screening programme - slightly lower than the aerage across all countries at 35% The key things women associate with osteoporosis are increased risk of further fractures (three-quarters), reduced quality of life, long term pain, loss of height and fear of the next fracture/fall (all mentioned by two-thirds of women) <half the women with osteoporosis suspected they had the disease prior to diagnosis and only quarter of women were aware that they were at risk All of the sufferers said that the disease had a major impact on their quality of life - with the major impact being liing in fear of breaking a bone and/or back pain

40 Summary 40 8 of the 10 women said they would hae taken medication for preention if they had known they were at risk of osteoporosis 10 of the 13 women with osteoporosis said they would tell other women to take calcium supplements, 8 would tell others to take preentatie treatment, 7 to get screened and 6 would tell women to ask for specific osteoporosis medication Only 5% of women said they felt they were likely to deelop osteoporosis in the future and only a fifth of women were concerned about the long term health risks of the disease >half the women had discussed osteoporosis with a doctor (cf aerage of 44% across all countries)

41 41 Summary Of those that had discussed osteoporosis with a doctor, >third said the doctor initiated the discussion and <fifth raised it with a doctor because they thought they were at risk of a fracture >half the women who had discussed the disease with a doctor went on to discuss the long term health risks. Three-quarters of the women belieed that osteoporosis can be preented.

42 42 Summary Of the women who hae discussed osteoporosis with a doctor <half could not remember discussing therapy options. In total only a third of women were actually taking medication for osteoporosis/hormonal problems 5 of the 13 osteoporosis sufferers were not currently taking medication for the condition 8 out of 10 women would consider taking long term preentatie therapy if recommended by their doctor, with side effects being the main concern that they would hae (quarter). Howeer <third of women said nothing would stop them taking long term preention of recommended by their doctor

43 Summary 43 Almost all the women belieed that osteoporosis should be iewed as a serious condition 9 out of 10 women felt that it was ery important to effectiely preent spinal fractures 8 out of 10 women agreed that it is ery important to effectiely preent osteoporosis or they would know if they had a ertebral fracture 7 out of 10 women belieed that doctors hae enough resources to effectiely manage the disease A third of women said they would not wish to be screened for osteoporosis Half the women were concerned about the long term risks to their health of taking HRT

44 44 Summary <half the women felt that osteoporosis was a life-threatening condition 4 out of 10 women would like more information on the disease 4 out 10 women did not feel that doctors took osteoporosis seriously enough Three-quarters of women did not wish to take medication earlier to preent osteoporosis

45 ISO9000 German GPs 45 Ipsos-RSL

46 Clinics held in surgery Menopause Clinic Osteoporosis Clinic No 95% Yes 5% No 92% Yes 8% Across all countries aerage of 23% had menopause clinic and 20% osteoporosis clinic 46 Base: GPs aged <65 (n=100)

47 Q.3 Number post-menopausal women in practice Don't know 2,501+ 2,001-2,500 1,501-2,000 1,001-1, , % 1% 1% 5% 7% Aerage number patients: 488 s. aerage of all countries of % 21% % % <100 15% 47 Base: GPs aged <65 (n=100)

48 Q.4 Key health concern discussed Back pain Depression Painful bones Vaginal atrophy Hypertension Hormonal probs 4% 4% 5% 8% 8% 8% Other concerns mentioned by 2 or less GPs Across all countries 34% said osteoporosis was key health concern Heart/Cardio 12% Hot flushes 13% Bone/osteoporosis 26% 48 Base: GPs aged <65 (n=100)

49 Q.4/5 Total mentions of health concerns None/DK Vaginal atrophy Hypertension Hormonal problems Depression 7% 12% 19% 24% 25% Other concerns mentioned by <10% of GPs Across all countries 63% of doctors were concerned about osteoporosis Hot flushes 31% Heart/Cardio 33% Bone/osteo 64% 49 Base: GPs aged <65 (n=100)

50 Q.6 Approach to health risk assessment 15% 41% Across all countries 65% proactiely/routinely conduct assessments s. 56% in Germ 27% 17% Proactiely Routinely Occasionally Neer 50 Base: GPs aged <65 (n=100)

51 51 Q.7 Limiters on health status reiews Base: All GPs 100 Reimbursement/Lack of funding 39% Lack of time 22% Reluctance from patients 8% Patients don t request this 5% Not a priority 4% Refer to nurse/specialist to do this 3% Nothing 14% DK/NA 12% Others mentioned by indiidual GPs

52 52 Q.8a Definition of treatment Base: All GPs 100 Starting medication when woman has deeloped o/p 39% Starting treatment when woman is at risk of deeloping 30% Drug/Product class mentions 21% Lifestyle changes 18% Starting med. when a woman has experienced fracture 8% Radiology/Bone density scan eidence 7% DK/NA 1%

53 53 Q.8b Definition of preention Base: All GPs 100 Adising the woman on how to make lifestyle changes 62% Starting medication before at risk of deelopment 17% Drug/product class mentions 14% Screening patients when they reach the menopause 5% DK/NA 1% Others mentioned by <=2% of GPs

54 54 Q.9 Most negatie effects of osteoporosis Base: All GPs 100 Fracture/breaking a bone 76% Pain 42% Curature of spine 18% Limiting affect on lifestyle 16% Less mobility 7% Debilitation 4% Lack of independence 3% Depression 2% Bone loss 2% None 1% Other responses mentioned on indiidual basis

55 Q.10 % patients rxd medication for treatment of osteoporosis Don't know 3% 90%+ 80 to to to to to 49 6% 3% 4% 5% 8% 15% Aerage: 37% s. aerage of all countries of 42% 30 to 39 12% 20 to 29 14% 10 to 19 20% 1 to 9 10% 55 Base: GPs aged <65 (n=100)

56 Q.11 % patients rxd medication for preention of osteoporosis Don't know 7% 90%+ 80 to to to to to to 39 1% 3% 3% 3% 5% 8% 8% Aerage: 22% s. aerage of all countries of 45% 20 to 29 9% 10 to 19 14% 1 to 9 13% None 26% 56 Base: GPs aged <65 (n=100)

57 Q.12a Inhibitors of rxing medication for preention Base: All GPs 100 Cost 55% None 21% Do not beliee should Rx preentatie medicine 8% Prefer to adocate lifestyle changes 6% 57 In total 59% cited cost/lack of funding as inhibitor (s. 33% of all doctors) and 5% cited side effects/compliance (s. 20%

58 58 Q.12b Biggest challenge when treating preentatiely after menopause Base: All GPs 100 Compliance 25% Patients see no need for treatment 16% Patients concern about side effects 9% Cost 9% Patients lack of understanding about LT health risks7% Nothing 15% DK/NA 4% Other responses mentioned by <5% of GPs

59 Q.19 Physicians most likely to rx medication for osteoporosis Internist GP Gynaecologist 16% Other physician types mentioned by <10% of GPs Orthos much more likely to rx in Germany than in other countries (29%) 73% 76% Orthopaedist 81% 59 Base: All GPs (n=100)

60 60 Q.20 Factors affecting decision to rx long term medication Base: All GPs 100 Cost 35% Seriousness of illness 25% Compliance 18% Well tolerated 18% Side effects 12% Effectieness 11% Bone scan report 7% Patients age 6% Others mentioned by <5% of respondents

61 Q.21 Whether women consult at early enough stage No 59% DK 10% Yes 31% Base: All GPs (n=100) 61

62 62 Q.22 Most important feature of osteoporosis product Base: All GPs 100 Efficacy 22% Increases bone mass density 21% Tolerability 15% Stops fractures (other than ertebral) 9% Preents pain 7% Conenient to take 7% DK/NA 1% Other features mentioned by <5% of GPs.

63 Q.22/23 Important feature of osteoporosis product Base: All GPs 100 Tolerability ^ 59% Efficacy * 34% Cost effectie 33% Increases bone mass density * 30% Conenient to take ^ 21% Stop fractures (other than ertebral) * 12% Preents pain 11% Side effects ^ 7% Effectiely stops ertebral fractures * 6% Reduces bone turnoer * 6% 63 * Mentioned by 75% of GPs ^ Mentioned by 71% of GPs

64 64 Q.24 Ideal candidates for preentatie medication (prompted) Base: All GPs 100 Women with ertebral fracture 83% Women with family history of osteoporosis 81% Women at high risk of ertebral fracture 81% Women at high risk of hip fracture 80% Women with history of hip fracture 77% Women who are going through early menopause 76% Peri-menopausal women 37% Women at risk from deeloping breast problems 29% Women at risk from deeloping cardiac problems 28% Asymptomatic post menopausal women 26% None/DK 7%

65 Q.25 Therapy/lifestyle recommendations suggest to women None/DK Vit D Reduce alcohol Light exercise Weight management Sunlight Reduce/stop smoking 3% 6% 8% 9% 12% 12% 16% Other recommendations mentioned by <5% of GPs Increase Calc intake 42% Right diet 53% Incr exercise 86% 65 Base: All GPs (n=100)

66 Q.26 Extent of agreement Compliance is an important factor in drug s efficacy Strongly agree Agree Disagree 1% 22% Mean: 3.7 Strongly agree +4 Strongly disagree +1 73% Strongly disagree 2% 66 Base: All GPs (n=100)

67 Q.27 Reasons for non-compliance DK/NA Inconenient to take Ignore seerity Lack of knowledge Compliance 1% 8% 12% 12% 14% Other recommendations mentioned by <7% of GPs Hae no symptoms 20% Side effects 26% 67 Base: All GPs (n=100)

68 Q.28 Whether patient has refused recommended o/p treatment No 56% Yes 44% 68 Base: All GPs (n=100) Across all countries 61% of doctors said patients had refused treatment

69 Q.29 Reasons why patients refuse treatment No symptoms Don t want to bleed Inconenient to take Don't want l/t med Don't want hormones 7% 7% 9% 11% 11% Other recommendations mentioned by <5% Lack of compliance 16% Dislike of medicine 18% Fear of SE 34% 69 Base: Doctors whose patients hae refused recommended medication (n=44)

70 70 Q.30 Agreement with statements Base: All GPs 100 Our goal should be preenting women suffering 1 st fracture 98% Osteoporosis should be iewed as a serious condition 95% Main aim of O/p management is to pre. occurrence of fractures95% The screening programme in this country could be improed 92% Osteoporosis fractures are a major clinical problem 86% If you preent ertebral fractures you can stop secondary ones81% Often O/p is not diagnosed until a woman has a fracture 80% A medicine that treats is >efficacious than a preentatie 59% Bone fragility is an ineitable factor of growing old 33% The screening programme for o/p is sufficiently widespread 19% The screening programme for o/p is sufficiently funded 4%

71 ISO9000 Summary 71 Ipsos-RSL

72 72 Summary 5% of GPs run a menopause clinic (s. aerage of 23%) and 8% run an osteoporosis clinic (s. aerage of 20%) On aerage the GPs estimated they had 488 postmenopausal women in their practice s. aerage of 903 across all countries in the research >quarter of GPs said their key health concern with the postmenopausal women in their practice was osteoporosis, followed by just >tenth saying hot flushes or heart disease Looking at all health concerns GPs hae, in total two-thirds mentioned osteoporosis, followed by heart disease and/or hot flushes (third)

73 73 Summary >half the GPs claimed to either proactiely or routinely conduct health risk assessments amongst their postmenopausal women (cf two-thirds across all countries), although >tenth claimed to proactiely conduct them >third of GPs said the main limitation on the number of health status reiews conducted was reimbursement/lack of funding issues. >fifth said lack of time was the reason why they were limited in conducting reiews >third of GPs defined treatment as starting medication when a woman has already deeloped osteoporosis whilst <third defined it as starting treatment when a woman is at risk of deeloping the disease. A fifth defined it as suggesting lifestyle changes which the women can make

74 Summary 74 Two-thirds of GPs defined preention as adising women on lifestyle changes (s. 45% across all countries), whilst <fifth defined it as starting medication before the woman is at risk of deeloping the disease therefore GPs in Germany haen t really bought into preention through medication Three-quarters of the GPs felt that the most negatie effect of osteoporosis was fractures that the women can experience. <half felt it was the pain the women experience. On aerage a third of postmenopausal patients are currently receiing medication for treatment of osteoporosis and a fifth are on medication for preention low cf other countries (aerage of 45% on preention)

75 75 Summary The main thing which inhibits GPs from rxing medication for preention is the cost (>half cf third of all doctors). A fifth of GPs said they didn t think anything inhibited their rxing of preention medicine - clearly not the case as relatiely low proportion of patients receiing this type of medication

76 76 Summary There are 3 key physician types in the area of osteoporosis - Orthopaedists, Gynaecologists and GPs In German orthopaedists are much more likely to rx in this disease area compared to other countries sureyed A third of GPs said that cost of treatment was a factor which affected their decision when rxing long term medication. A quarter said the seriousness of the condition was a factor and <fifth compliance and or tolerability

77 Summary 77 >two-thirds of GPs said that they do not think women consult at an early enough stage The two most important features of an osteoporosis product were felt to be efficacy and the impact on increasing BMD (fifth) In total three-quarters of doctors felt that an important feature of osteoporosis product was efficacy and/or tolerability In terms of ideal patient types for preentatie medicine, there was low agreement that they would be asymptomatic of postmenopausal women, women at risk from deeloping cardiac problems, women at risk of deeloping breast problems and peri-menopausal women

78 78 Summary 9 out of 10 GPs recommend that women increase their exercise intake and 5 out of 10 adopt the right diet. 4 out of 10 suggest to women that they increase their calcium intake Almost all the GPs (95%) agreed that compliance is an important factor in a drug s efficacy, with the main reason for non-compliance being side effects (quarter) or the fact the patient is not experiencing any symptoms (fifth) 4 out of 10 GPs said they had experienced women who had refused recommended treatment mainly because of a fear of side effects (third)

79 79 Summary Almost all the GPs agreed that their goal should be to preent women from suffering a first fracture, that the disease should be iewed as a serious condition and the main aim is to preent the occurrence of fractures 8 out of 10 GPs agree that osteoporosis fractures are a major clinical problem, that if you preent ertebral fractures you can stop secondary ones and often osteoporosis is not diagnosed until a woman has a fracture A third of GPs agree that bone fragility is an ineitable factor of growing old

80 80 Summary 9 out of!0 GPs beliee that the screening programme could be improed Only 4% of GPs felt that the screening programme was sufficiently funded

81 ISO9000 Conclusions and Recommendations 81 Ipsos-RSL

82 82 Awareness

83 83 Awareness 9 out of 10 women said that osteoporosis is a serious disease 80% of all women suffering from osteoporosis were not aware they were at risk Three-quarters of sufferers were not aware that they had the disease prior to diagnosis 95% of doctors think that osteoporosis should be iewed as a serious condition 86% of doctors feel that osteoporosis fractures are a major clinical problem Two-thirds of doctors cited osteoporosis as a health concern that they hae amongst their postmenopausal patients. Howeer only a third of postmenopausal women stated they were concerned about the disease

84 84 Awareness Just oer half the women had discussed osteoporosis with a doctor and of these, 38% said their doctor initiated the discussion Two-fifths of the women who hae discussed the disease with a doctor hae NOT discussed long term risks, mainly because the doctor did not raise them or they neer thought about it 1 in 3 women will deelop osteoporosis none of the women stated that they feel they are ery likely to deelop the condition and only a 6% are ery concerned about the long term health risks of osteoporosis

85 85 Awareness Greater education is required amongst postmenopausal women the biggest challenge doctors face is unwillingness of women to take long term medication greater education will generate a greater understanding of the disease and its consequences women will then be more concerned about osteoporosis and become more proactie in preention/management

86 86 Impact on Daily Life

87 87 Impact on Daily Life Three-quarters of doctors stated that the most negatie effect of osteoporosis was fractures/breaking a bone, followed by pain Three-quarters of women associate osteoporosis with an increased risk of fracture, two-thirds with a reduced quality of life, long term pain, loss of height or fear of the next fracture/fall Of the women with osteoporosis, all stated that it had impacted on their quality of life (leaing in fear of breaking a bone, back pain, cannot lift heay weights) Two-thirds of women who hae suffered a fracture as a result of osteoporosis said it took oer two months to recoer from the fracture 80% of osteoporotics said they would hae taken preentatie medicine if they had known they were at risk

88 88 Impact on Daily Life Gien the impact of these effects, why are only 37% of postmenopausal women on medication for treatment (s. >tenth of women who claim to be on treatment) If these women had been gien earlier preentatie medicine, the negatie effects may hae been aoided

89 89 Screening

90 Screening 90 Almost all the GPs said that their goal should be to preent a first fracture, that osteoporosis should be iewed as a serious condition and that the main aim of management was to preent fracture Howeer only just oer half of women hae been screened for osteoporosis and on screening, 92% of women were identified as suffering from the disease If screening identifies the disease - why hae none of the patients been recommended screening by their own doctor? 9 out of 10 doctors beliee the screening programme should be improed 96% of doctors beliee that the screening programme is NOT sufficiently funded 8 out of 10 doctors beliee the screening programme is NOT sufficiently widespread

91 Screening 91 Just oer half the doctors think they either proactiely or routinely conduct health risk assessments, in reality when asked for their definition of preention, only 5% said screening when a patient reaches the menopause Despite wanting to preent osteoporosis, doctors are not actiely following this up ia screening Three-quarters of women were not aware that screening is een aailable Due to this lack of awareness, it is not surprising that only 15% of women strongly agree that osteoporosis can be preented Two-thirds of doctors feel that women do NOT consult at an early enough stage

92 92 Screening The screening serice clearly needs to be improed and promoted screening should take place earlier, leading to earlier diagnosis this will lead to long term preention of fractures 81% of women stated that they would know if they had a ertebral fracture Women must be educated that osteoporosis can be a silent disease and that as soon as they go through the menopause they must actiely request to be screened

93 93 Effectie Preention and Treatment

94 94 Effectie preention and treatment 8 out of 10 doctors beliee that osteoporosis fractures are a major clinical concern but only 22% of postmenopausal women are on preentatie medicine Two-thirds of doctors defined preention as giing lifestyle adice rather than rxing medication Oer a third of osteoporosis sufferers are NOT on medication Howeer four-fifths of osteoporotics would hae taken preentatie medicine if they had known they were at risk Women would take preentatie medicine if their doctor recommended it Two-fifths of doctors hae experienced patients refusing to take long term preentatie medicine, mainly because they hae a fear of side effects

95 95 Effectie preention and treatment 81% of doctors beliee that ideal candidates for preention are women at risk of a ertebral fracture Women need to understand why they should be on long term medication this should lead to an increase in the number of women being placed on medication and, more importantly, staying on medication Only 14% of women who had discussed osteoporosis with a doctor discussed osteoporosis medication options Howeer, doctors estimated that 22% of their postmenopausal women patients are on preentatie medication and 37% are rxd treatment

96 96 Effectie preention and treatment 5 out of 10 women are concerned about the long term effects of HRT doctors need to be made aware of these concerns so that patients comply with treatment When asked which features doctors consider important in an osteoporosis treatment, three-quarters said conenience / tolerability / GI side effects

97 97 Effectie preention and treatment In turn women need to hae a greater awareness that there are specific treatments as only just oer a quarter indicated that osteoporosis can be preented by the use of specific osteoporosis medications

98 98 Prescribing Inhibitors

99 99 Prescribing inhibitors A third of doctors say cost/lack of funding is the greatest factor affecting their decision to rx a medication A quarter of doctors think that the biggest challenge they face is lack of compliance A fifth of doctors said a compliance or tolerability affects their decision as to rxing long term medication, followed by side effects (>tenth) This in turn leads to an aerage of 63% of patients NOT being rxd medication for the treatment of osteoporosis and 78% NOT being prescribed preentatie medicine Two-fifths of doctors hae experienced patients refusing to take long term medication

100 100 Prescribing inhibitors >quarter of doctors cite side effects as the main reason for non-compliance and a fifth claim that the women don t comply because they are not experiencing symptoms Lobbying is required to create more funds to inest in this condition Again, doctors need to be educated that there are specific osteoporosis medications which are cleaner than those currently used With greater education amongst patients, concerns about long term medication will be put to rest

101 Key Recommendations 101 It is clearly obious from the results of this surey that both doctors and postmenopausal women need greater education on the disease If women receie preentatie medicine, the widely reported negatie effects of the disease will be aoided The screening serice needs to be improed and promoted Women need to understand that osteoporosis is a silent disease and they should actiely ask to be screened when reaching the menopause Women need to understand the benefits of long term medication Doctors need to be aware that there are specific osteoporosis products aailable which proide eerything that they are asking for