The perspectives and experiences of osteoporosis, falls and fracture prevention in patients with chronic inflammatory rheumatic disease: A qualitative study

Objective To describe the perspectives of patients with chronic inflammatory rheumatic diseases (CIRD) regarding osteoporosis, falls and fractures in order to develop a theoretical framework to explain healthcare perceptions and key impacts, which may guide development of consumer-focussed interventions to improve care. Methods Patients ≥ 50 years with rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis or systemic lupus erythematosus and a concurrent diagnosis of osteoporosis were purposively sampled from two rheumatology services based in metropolitan tertiary hospital to participate in a focus group or interview. Transcripts were thematically analysed. Results Six main themes were identified: Ambivalence towards diagnoses, changing identity and loss of confidence, complexities of management in rheumatic disease, embracing own health autonomy, entrusting care in healthcare providers and expectations for proactive care. Conclusion Patients living with CIRD may be ambivalent to osteoporosis, falls and fractures, but also fearful of the consequences to their identity and function. They value proactive care from their clinicians that addresses osteoporosis and falls prevention. Many feel their educational needs around these risks are unmet and look to clinicians for support that empowers them, fosters acceptance and acknowledges the potential threat these conditions post to independence and identity. Future interventions should incorporate patient-centred educational models and provide clinicians with the resources needed to offer meaningful preventive care.