Sir, I read with interest the article by Hiligsmann and colleagues  describing the use of a discrete choice experiment (DCE) tool to investigate patient preferences for different osteoporosis treatments across Europe. While providing some valuable insights, the paper raises a number of issues. The authors touch on these in the discussion, but do not fully bring out all the implications for the overall message. The first is the use of a DCE in the area of osteoporosis therapy. The authors acknowledge it has not been validated in this field. For a condition that is largely asymptomatic, and where there is a very rapid fall in compliance with treatment within the first few months even in patients who have suffered painful fractures , the utility of a DCE approach in asking a patient to contrast a hypothetical adverse effect with an imagined long term outcome is surely open to question. Every physician working in the field will have experienced a patient who swore absolute and conscientious compliance with medication, only for the truth to emerge of failure to take almost any treatment. It is difficult to see without a lot more validation work where a DCE tool fits into this scenario. The second is the failure to include osteonecrosis of the jaw or atypical femoral fracture as potential adverse events. Although these may in actual practice be rare, many patients are very concerned about them [3, 4]; my experience is that they are the most discussed potential side effect of osteoporosis therapy in the clinic in the last 18 months, and for them not to be included in the project seems a significant omission, for which the authors offer no explanation. Funding: No specific funding was received from any funding bodies in the public, commercial or not-for-profit sectors to carry out the work described in this manuscript. Disclosure statement: D.A. has received speaker fees from Internis Pharma and Consilient Health. References 1 Hiligsmann M, Dellaert BG, Dirksen CD et al. Patients’ preferences for anti-osteoporosis drug treatment: a cross-European discrete choice experiment. Rheumatology 2017; 56: 1167– 76. Google Scholar CrossRef Search ADS PubMed 2 Solomon DH, Avorn J, Katz JN et al. Compliance with osteoporosis medications. Arch Intern Med 2005; 165: 2414– 9. Google Scholar CrossRef Search ADS PubMed 3 Carr AJ, Thompson PW, Cooper C. Factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis: a cross-sectional survey. Osteoporosis Int 2006; 17: 1638– 44. Google Scholar CrossRef Search ADS 4 Martín-Merino E, Huerta-Álvarez C, Prieto-Alhambra D, Montero-Corominas D. Cessation rate of anti-osteoporosis treatments and risk factors in Spanish primary care settings: a population-based cohort analysis. Arch Osteoporosis 2017; 12: 39. Google Scholar CrossRef Search ADS © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: firstname.lastname@example.org
Rheumatology – Oxford University Press
Published: Mar 1, 2018
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