Phase 2: qualitative research Phase 2 comprised a cross-sectional, selleck inhibitor iterative, qualitative investigation to determine the impact of osteoporosis

on patients’ lives, to evaluate the suitability of the interim version of OPAQ generated in phase 1 as an endpoint in clinical trials, and to clarify the conceptual focus of the final instrument. This involved conducting concept elicitation and cognitive debriefing interviews on the interim version of the OPAQ. Interviews were conducted in 2010 and 2011 according to a semi-structured guide. This study phase was conducted in two discrete stages (‘first stage’ and ‘second stage’), each with a separate recruitment process. Substantial modifications were made to the instrument between these stages so that it focused solely on physical function in the second stage. Interviews were audio-recorded and transcribed to facilitate selleck products data analysis. Methodology and analyses were in line with the US Food and Drug Administration (FDA)’s guidance on PRO instrument development and modification,

and recent International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations [17–19]. Demographic and interview data are reported separately for the two stages of this phase. Study population Participants were recruited through three clinical sites in the USA. Full Institutional Review Board (IRB) approval was obtained from the Western IRB, Olympia, Washington, USA (first stage), and the Independent IRB, Plantation, Florida, USA (second stage), prior to patient recruitment. Inclusion criteria were: female gender, ≥50 years Cyclin-dependent kinase 3 of age, ambulatory (able to walk

with or without assistance), and diagnosis of osteoporosis at least 1 year previously. The final study population included patients with osteoporosis of differing degrees of severity (who were therefore at different levels of fracture risk), and patients who had, and had not, experienced an osteoporosis-related fracture. Patients were allocated by a clinician to one of three diversity groups, according to the following inclusion criteria: Diversity group 1: (T-score between −1.0 and −2.5 at the femoral neck or spine and 10-year probability of hip fracture ≥3 %) or 10-year probability of major osteoporosis-related fracture ≥20 %. Fracture probabilities were based on the World Health Organization’s ‘FRAX®’ algorithm, which estimates 10-year probabilities of hip fracture and major osteoporotic fracture (defined as clinical vertebral, hip, forearm, or proximal humerus fracture) based on the patient’s femoral neck bone mineral density and clinical risk factors [1]. Diversity group 2: T-score ≤ −2.5 and fragility fracture of the usual osteoporosis fracture sites (e.g., spine, wrist, hip, rib, or pelvis) in the past 12 months, as determined by the attending physician. Diversity group 3: T-score ≤ −2.