ORIGINAL ARTICLE Osteoporosis prevention: where are the barriers to improvement in a French general population? A qualitative study B. Merle 1 & C. Dupraz 2 & J. Haesebaert 3 & L. Barraud 2 & M. Aussedat 2 & C. Motteau 2 & V. Simon 2 & A.M. Schott 3 & M. Flori 2,4 Received: 18 January 2018 /Accepted: 24 September 2018 # International Osteoporosis Foundation and National Osteoporosis Foundation 2018 Abstract Summary We conducted a qualitative study with French men and women in order to provide insight into individuals’ experi- ences, behaviors, and perceptions about osteoporosis (OP) and OP care. The data showed that both sexes, but especially men, were unfamiliar with OP, did not always feel concerned, and mistrusted pharmacological treatments. Introduction To engage actively in osteoporosis (OP) prevention, people need to have basic knowledge about the disease. The aim of this qualitative study was to explore knowledge and representations of OP care and prevention among both men and women. Methods Focus groups were conducted in the Rhône-Alpes Region, France, with women aged 50–85 years and men aged 60– 85 years, with or without a history of fragility fracture and/or an OP diagnosis (respectively referred to as Baware^ or Bunaware^). A total of 45 women (23 Baware^ and 22 Bunaware^ in 5 and 4 focus groups, respectively) and 53 men (19 Baware^ and 34 Bunaware^ in 3 and 4 focus groups, respectively) were included. A thematic analysis of transcripts was performed to explore knowledge and representations about OP, risk factors, prevention, and treatment. Results The data showed that both sexes, but especially men, had limited knowledge of OP and considered it as a natural aging process not related to fragility fractures. They generally did not feel concerned by OP and no important difference was observed between Baware^ and Bunaware^ patients. Women expressed their fear of the disease, associated with aging and the end of life, while men considered it to be a women’ s disease only. Both sexes were aware of OP risk factors, but were suspicious towards treatments because of the associated side effects. Conclusion Understanding people’ s representation of OP might help to provide patients with relevant information in order to optimize their preventive behavior and decrease the burden of the disease. Keywords Focus groups . France . Men osteoporosis . Osteoporosis management . Qualitative research . Women osteoporosis Osteoporosis (OP) is a skeletal disease characterized by low bone density and alterations in bone micro-architec- ture, leading to increased bone fragility concerning pre- dominantly postmenopausal women but also men [1]. OP is responsible for fragility fractures associated with mor- bidity, loss of independence, and mortality. Although two thirds of the fractures occurred in women, half of all deaths concerned men [2]. With the aging of the popula- tion, OP is becoming a major public health issue world- wide with increasing human and financial costs. In France, reports estimated that in 2010, nearly 25% of women and 7% of men over 50 years of age were con- cerned by OP, with 4300 deaths directly attributed to OP fractures [3, 4]. The financial cost of OP for pharmaco- logical prevention and fracture care is significant and has been estimated in 2010 at 3.5 billion euros and 1.3 billion euros for French women and men, respectively, mostly for hip fractures [2, 4, 5]. Various national and international guidelines have been developed to assess bone status and improve OP management * B. Merle blandine.merle@inserm.fr 1 INSERM Research Unit 1033, Université Lyon 1, Lyon, France 2 Collège Universitaire Médecine Générale, Université Lyon 1, Lyon, France 3 Hospices Civils de Lyon, HESPER EA 7425, Université Lyon 1, Lyon, France 4 EA 4129-Parcours Santé Systémique, Université Lyon 1, Lyon, France Osteoporosis International https://doi.org/10.1007/s00198-018-4720-5