Family physicians' attitudes and practice on screening and prevention of fragility fractures, and shared decision-making with postmenopausal women : a qualitative study in Spain
León-García, Montserrat (Universitat Autònoma de Barcelona. Departament de Pediatria, Obstetrícia i Ginecologia i de Medicina Preventiva i Salut Pública)
Cánovas Martínez, Esther (Institut de Recerca Sant Pau)
Álvarez Pérez, Yolanda (Canary Islands Health Research Institute Foundation (FIISC))
Pou, María Antonia (Institut Universitari d'Investigació en Atenció Primària Jordi Gol)
López García-Franco, Alberto (Equipo de Atención Primaria "Doctor Mendiguchía Carriche" Leganes)
Sanz Bas, Ana (Institut Català de la Salut)
Rodriguez-Moreno, Sara (Universidad Europea de Madrid)
Delgado Espinoza, Claudia Erika (Universitat Autònoma de Barcelona. Departament de Farmacologia, de Terapèutica i de Toxicologia)
Roca, Pablo (Universidad Villanueva)
González Osuna, Aránzazu (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Fernández Valverde, Diana (Institut de Recerca Sant Pau)
Marín Nanco, Betzabeth (Universidad Santo Tomás (Xile))
Medina-Aedo, Melixa (Institut de Recerca Sant Pau)
Perestelo-Pérez, Lilisbeth (Canary Islands Health Service (SCS))
Alonso-Coello, Pablo (Institut de Recerca Sant Pau)

Date:	2025
Abstract:	Osteoporosis is a prevalent condition among postmenopausal women, significantly increasing the risk of fragility fractures. Despite the availability of clinical guidelines, their implementation in primary care, remains highly variable, particularly regarding fracture prevention and shared decision-making (SDM). We conducted a qualitative study to explore the attitudes and practices of Spanish family physicians in preventing fractures among postmenopausal women. Sixteen semi-structured interviews were conducted with physicians from diverse socioeconomic backgrounds and levels of clinical experience. Data were analysed using an iterative, theory-driven approach to identify key themes and barriers. Physicians showed substantial variability in fracture risk assessment approaches, frequently combining tools such as FRAX with clinical judgment. Most were cautious about prescribing bisphosphonates for primary prevention, citing concerns about the strength of the evidence and potential adverse effects. While non-pharmacological strategies, such as lifestyle modifications and fall prevention, were emphasized, their implementation was often constrained by workload pressures. Patient involvement in decision-making was hindered by widespread misconceptions about osteoporosis and its treatment, as well as the lack of appropriate decision-support tools. Participants highlighted the need for clearer guidelines, enhanced educational resources, and accessible decision aids to facilitate patient engagement in care. This study highlights the complex challenges family physicians face in fracture prevention among postmenopausal women, including heterogeneity of recommendations in guidelines, limited SDM implementation, and systemic barriers within primary care. Addressing these issues will require multifaceted interventions targeting both healthcare system constraints and patient education. Future efforts should focus on developing and implementing strategies that support evidence-based, patient-centred decision-making while accounting for the realities of primary care practice.
Grants:	Instituto de Salud Carlos III PI20/00681
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Osteoporosis ; Fragility fractures ; Primary prevention ; Primary healthcare ; Shared decision-making
Published in:	BMC Primary Care, Vol. 26 Núm. 1 (August 2025) , ISSN 2731-4553

DOI: 10.1186/s12875-025-02966-z
PMID: 40835900

13 p, 1.7 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles