Patients’ preferences for fracture risk communication: the Risk Communication in Osteoporosis (RICO) study

Charlotte Beaudart, Mitali Sharma, Patricia Clark, Saeko Fujiwara, Jonathan D. Adachi, Osvaldo D. Messina, Suzanne N. Morin, Lynn A. Kohlmeier, Caroline B. Sangan, Xavier Nogues, Griselda Adriana Cruz-Priego, Andrea Cavallo, Fiona Cooper, Jamie Grier, Carolyn Leckie, Diana Montiel-Ojeda, Alexandra Papaioannou, Nele Raskin, Leonardo Yurquina, Michelle WallOlivier Bruyère, Annelies Boonen, Elaine Dennison, Nicholas C. Harvey, John A. Kanis, Jean François Kaux, E. Michael Lewiecki, Oscar Lopez-Borbon, Zoé Paskins, Jean Yves Reginster, Stuart Silverman, Mickaël Hiligsmann

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Summary: The RICO study indicated that most patients would like to receive information regarding their fracture risk but that only a small majority have actually received it. Patients globally preferred a visual presentation of fracture risk and were interested in an online tool showing the risk. Purpose: The aim of the Risk Communication in Osteoporosis (RICO) study was to assess patients’ preferences regarding fracture risk communication. Methods: To assess patients’ preferences for fracture risk communication, structured interviews with women with osteoporosis or who were at risk for fracture were conducted in 11 sites around the world, namely in Argentina, Belgium, Canada at Hamilton and with participants from the Osteoporosis Canada Canadian Osteoporosis Patient Network (COPN), Japan, Mexico, Spain, the Netherlands, the UK, and the USA in California and Washington state. The interviews used to collect data were designed on the basis of a systematic review and a qualitative pilot study involving 26 participants at risk of fracture. Results: A total of 332 women (mean age 67.5 ± 8.0 years, 48% with a history of fracture) were included in the study. Although the participants considered it important to receive information about their fracture risk (mean importance of 6.2 ± 1.4 on a 7-point Likert scale), only 56% (i.e. 185/332) had already received such information. Globally, participants preferred a visual presentation with a traffic-light type of coloured graph of their FRAX® fracture risk probability, compared to a verbal or written presentation. Almost all participants considered it important to discuss their fracture risk and the consequences of fractures with their healthcare professionals in addition to receiving information in a printed format or access to an online website showing their fracture risk. Conclusions: There is a significant communication gap between healthcare professionals and patients when discussing osteoporosis fracture risk. The RICO study provides insight into preferred approaches to rectify this communication gap.

Original languageEnglish
Pages (from-to)451-468
Number of pages18
JournalOsteoporosis International
Issue number3
Publication statusPublished - 13 Nov 2023


  • Fracture
  • FRAX®
  • Osteoporosis
  • Patient-healthcare professional communication
  • Risk communication
  • Shared decision-making
  • Visual aids


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