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This study aims to understand how osteoporosis medication acceptance varies across countries with differing guidance on treatment threshold and influence of clinical and demographic factors. A total of 79.2% accepted treatment at a fracture probability at or below the treatment threshold. Fracture history and age did not strongly impact acceptance, suggesting a need for improved fracture risk communication. Purpose: This part of the Improving Risk Communication in Osteoporosis (RICO) study aims to understand patients' willingness to initiate osteoporosis treatment given a hypothetical fracture probability-derived from the FRAX® Risk Assessment Tool-and how age, fracture history, and numeric literacy may influence this. Methods: In 2022-2023, 332 postmenopausal women at risk of fracture were interviewed from nine countries to determine participants' Fracture Risk Decision Point (FRDP), the lowest probability of major osteoporotic fracture at which they would accept an osteoporosis medication. Participants' FRDP was evaluated given eight hypothetical 10-year FRAX scores. Results: In countries with FRAX-based treatment thresholds, over half of the participants per country reported an FRDP that was below the threshold. Collectively, 79.2% demonstrated FRDPs at or below their respective threshold. Age and fracture history did not have a strong influence on FRDP; however, those who demonstrated higher levels of numeric literacy reported a significantly higher median FRDP (10%) compared to those who showed lower levels (5%, p < 0.001). Conclusions: Most patients were willing to accept an osteoporosis medication prescription at a hypothetical FRAX probability that was even lower than that of their nationally recommended treatment threshold. Literacy scores had a significant influence on FRDP whereas age and fracture history did not.
(2025) Sharma, Mitali; Beaudart, Charlotte; Clark, Patricia; Fujiwara, Saeko; Adachi, Jonathan D.; Papaioannou, Alexandra; Messina, Osvaldo D.; Morin, Suzanne N.; Kohlmeier, Lynn (2024) Cruz-Chamorro, Dario Alexander; Caguana Vélez, Oswaldo Antonio; Martínez-Tomás, Raquel
Vertically binding precedents are often rejected in the civil law tradition by reference to three interrelated arguments: (1) judges do not create the law, they merely apply it; (2) judges are bound by statutory law, not by the decisions of other judges; and (3) statutes, not the judicial decisions that interpret and apply them, are sources of law. This chapter addresses the three arguments and argues that precedents can have binding force even in countries where their very existence is highly contested. First, it is argued that judges of higher courts engage in important creative activity when they interpret the law, so that we can speak of genuine precedents governing the interpretation of the law, which add something new to the law. Secondly, it is shown that the binding force of these precedents in civil law countries can be quite robust, especially when compared to systems where their bindingness is generally accepted. The final section discusses the extent to which precedents that interpret the law can be considered sources of law.
(2023) Ramírez-Ludeña, LorenaResistance exercise and protein supplementation are recognized as effective treatment strategies for age-related sarcopenia; however, there are limited data on their feasibility, tolerability, and safety. The primary outcome of this study was feasibility, evaluated through the 15-item TELOS (Technological, Economics, Legal, Operational, and Scheduling) feasibility components and by recruitment, retention, and consent rates. Tolerability was measured by examining permanent treatment discontinuation, treatment interruption, exercise dose modification, early termination, rescheduling of missed sessions, losses to follow-up, attendance, and nutritional compliance. Safety was evaluated using the parameters provided by the European Medicines Agency, adapted for exercise interventions. Thirty-two subjects were recruited (average age 81.6 [SD 9.3] years). The TELOS components were assessed before the intervention; out of 15 questions relevant for successful implementation, 4 operational needs answers required specific actions to prevent potential barriers. The recruitment rate was 74%. Eleven patients (34.4%) had permanent treatment interruption (retention rate = 65.6%). Patients attended a mean of 23 (SD 12.0) exercise sessions, with a mean of 56 (SD 32.6) nutritional compliances. A total of 21 patients (65.6%) experienced adverse events unrelated to the intervention, while 7 patients (21.9%) presented adverse reactions to strength exercise. The main barriers to feasibility were operational components and recruitment challenges. Although the intervention was generally safe, the high rate of probable adverse effects, unrelated to the intervention but associated with the individual's baseline health condition, may affect adherence to treatment programs of this kind.
(2024) Meza Valderrama, Delky; Sánchez-Rodríguez, María Dolores; Curbelo Peña, Yulibeth; Ramírez-Fuentes, Cindry; Muñoz Redondo, Elena; Morgado Pérez, Andrea; Ortíz-Agurto, Norma; Finis-Gallardo, Paola; Marco Navarro, Ester (2024) Marcos-Delgado, Alba; Schröder, Helmut, 1958-; Zomeño Fajardo, María Dolores; Castañer, Olga; Fitó Colomer, Montserrat; Nieto, Javier