SUN-374 Decisions to Accept or Decline Pharmacologic Osteoporosis Therapy After Attending a Novel Patient-Centred Educonsult Program for Osteoporosis (PEP-OP)
Authors: Liu Crystal Sixian , Feasel Lynn , Kline Gregory A , Billington Emma O 
Published: May 2020

Abstract
Osteoporosis affects &gt;200 million people, resulting in &gt;8.9 million annual fragility fractures worldwide. Available medications can reduce fracture risk by 40–60%, although access to specialty osteoporosis services is limited, and many individuals remain unaware of their fracture risk and their treatment options. As the one-on-one ‘traditional consultation’ (TC) model of osteoporosis care is not time efficient (i.e. a single TC often requires &gt;45 minutes), there is a need to identify innovative consultative models that can improve accessibility to osteoporosis care while maintaining quality. At our Osteoporosis Centre, we have implemented a group counseling model for this purpose: the Patient-Centred Educonsult Program for Osteoporosis (PEP-OP). Each two-hour PEP-OP session - co-facilitated by an osteoporosis physician and a nurse - provides up to 10 patients (the equivalent to 3–5 half-day physician clinics under the TC model) with a combined consultative and educational experience consisting of an individualized fracture risk assessment and extensive review of medications available to lower fracture risk. Patients are then encouraged to make an informed, autonomous decision about osteoporosis treatment initiation. Although the PEP-OP can accommodate a greater patient volume than the TC, and we have previously reported that the PEP-OP results in high patient satisfaction, it is not known whether PEP-OP produce similar results compared to TC in terms of treatment decisions. In this cohort study, we compared decisions to initiate osteoporosis therapy in PEP-OP (N=100) and TC (N=43) attendees. Ten-year risk of major osteoporotic fracture was estimated for each participant using the FRAX calculator, and participants were stratified based on whether their ten-year risk was ≥20% or &lt;20%. Proportion of participants in each risk category who decided to initiate treatment were compared between the PEP-OP and TC groups. PEP-OP and TC groups were comparable in terms of age (63.3 vs 64.9 years), BMI (24.4 vs 24.9 kg/m2), previous fragility fractures (35 vs 25%), parental hip fractures (19 vs 23%), lumbar neck T-score (-2.5 vs -2.3), femoral neck T-score (-2.1 vs -2.1) and average FRAX estimate (13.1 vs 13.3%). The proportion of participants at high ten-year risk of major osteoporotic fracture (≥20%) who decided to initiate treatment was similar in both the PEP-OP (7/16, 44%) and TC (5/10, 50%) groups, according to the Chi Square Test (p=0.76). Among those with FRAX estimate of &lt;20%, a similar proportion of patients in the PEP-OP (15/84, 18%) and TC (4/33, 12%) groups chose to undergo treatment (X2, p=0.45). In summary, decisions to initiate pharmacologic therapy were similar for the PEP-OP and the TC. Considering that the PEP-OP is acceptable to patients and is more efficient than the TC, this care model should be considered by other centers wishing to improve access to high-quality osteoporosis care.