Results Phase 1 Unidimensionality was confirmed for each domain of the OPAQ v.2.0. Information generated by the ICCs A-1155463 nmr and IICs (available from the corresponding author) was used in conjunction with expert opinion (SS and DTG are both globally renowned key thought leaders on quality of life issues and measurement in osteoporosis) to make decisions regarding item deletion, retention, modification, or

subdivision (e.g., “How often did you have trouble either find more walking one block or climbing one flight of stairs?” was divided into two questions: “How often did you have trouble walking one block?” and “How often did you have trouble climbing stairs or steps?”). Items were included in the interim version of OPAQ only if deemed relevant to the overall concepts of physical function, fear of falling, independence, and symptoms that were the original intended focus of the final questionnaire. The primary reason for item retention was good endorsement of the concept by IRT curves. However, some items that measured a clinically important aspect of the underlying construct were retained based on expert opinion, even if their ICCs and IICs did not show well-distributed responses. Slight modifications to the wording of items and responses were based solely on expert opinion. The resulting interim version of

OPAQ contained 21 items in six domains: walking and bending (six items); sitting and standing (three items); transfers (four items); back ache and pain (two items); fear

of falling (three items); and independence (three items). Slight modifications to item wording and response option content (e.g., ‘very Tucidinostat often’ changed to ‘often’, and ‘almost never’ changed to ‘seldom’) were necessary to focus concepts on domains of interest, to improve clinical relevance, and to describe concepts as depicted by patients per expert opinion. Resulting response formats were: ‘all days’, ‘most days’, ‘some days’, ‘few days’, ‘no days’ for 15 questions, and ‘always’, ‘often’, ‘sometimes’, ‘seldom’, ‘never’ for the remaining six questions. Phase 2 This phase involved Tangeritin analysis of concept elicitation and cognitive debriefing data from 32 patients (first stage, 14 patients; second stage, 18 patients). All patients were receiving at least one prescription or non-prescription treatment for osteoporosis. Non-prescription treatments included calcium and vitamin D supplements. First stage: patient demographics Twenty-one patients (eight in diversity group 1, five in group 2, and eight in group 3) were recruited for the first stage of phase 2. However, data from seven of these participants were excluded from the analysis because of poor mastery of English (n = 1) or because they were unable to distinguish the symptoms and impacts of osteoporosis from those of other comorbid conditions (n = 6). These seven patients were white, with a mean (±standard deviation [SD]) age of 77.1 ± 10.