Multidisciplinary patient education in groups increases knowledge on osteoporosis: A randomized controlled trial Patient education in groups increases knowledge of osteoporosis and adherence to treatment: a two-year randomized controlled trial. A randomized controlled trial of mailed osteoporosis education to older adults Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice Improving adherence to and persistence with oral therapy of osteoporosis Impact of preventive osteoporosis education on patient behavior: immediate and 3-month follow-up Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal A blinded randomized controlled trial of motivational interviewing to improve adherence with osteoporosis medications: design of the OPTIMA trial Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial. Improving Care of Patients At-Risk for Osteoporosis: A Randomized Controlled Trial What is the impact of osteoporosis education and bone mineral density testing for postmenopausal women in a managed care setting? Educational outreach (academic detailing) regarding osteoporosis in primary care. Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. Community based intervention to optimize osteoporosis management: randomized controlled trial Impact of pharmaceutical care on knowledge, quality of life and satisfaction of postmenopausal women with osteoporosis Effects of bone density feedback and group education on osteoporosis knowledge and osteoporosis self-efficacy in premenopausal women: a randomized controlled trial.
Introduction : Specific pharmacological treatment reduces the incidence of fractures significantly in patients with osteoporosis . Unfortunately , compliance with such therapy is low in clinical practice and is inversely related to educational level . We hypothesized that patients '  knowledge of osteoporosis may be increased by a group-based multidisciplinary education programme . Methods : Three hundred patients , aged 45—81 years , recently diagnosed with osteoporosis and started on specific treatment  , were r and omized to either the " school ' ' or " control ' ' group . Teaching was performed by nurses , physiotherapists , dieticians , and doctors , and design ed to increase the patient 's empowerment . The patient 's knowledge of osteoporosis was tested at study entry and at 3 months using a vali date d question naire . Results : At study entry , no differences in age or score ( 22 ( 18—24 ) ( median ( 25—75 percentiles ) ) vs. 22 ( 18—24 ) ) were seen between the school and control groups . The change in knowledge during the study , however , differed significantly between the two groups ( p<0.001 ) . In the school group , the increase in knowledge score correlated inversely with the level of education ; that is , the lower the education level , the higher the gain in knowledge during the course ( Rho=-0.25 , p<0.01 ) . Conclusions : A group-based multidisciplinary education programme significantly increases patients ' knowledge of the disease OBJECTIVE Non-adherence to pharmacological treatment in osteoporosis is a well-recognized problem . We hypothesized that a group-based educational programme would increase patients ' knowledge and level of adherence with medical treatment . METHODS A total of 300 patients ( 32 men aged 65 ± 9 years and 268 women aged 63 ± 8 years ) , recently diagnosed with osteoporosis , were r and omised to either an  osteoporosis school programme  ( four classes of 8 - 12 participants over four weeks ) or a control group .  Teaching was multidisciplinary , based on patients ' experiences and background and design ed to encourage empowerment . Patients ' knowledge about osteoporosis and adherence to treatment was assessed with self-completed question naires at baseline and after 3 , 12 , and 24 months . RESULTS There were no significant differences at baseline between the two groups with respect to knowledge score or level of adherence . At two years ' follow-up , the improvement in knowledge score was 2 [ 0 - 4 ] points ( median [ 25 - 75 percentiles ] ) in the school group and 0 [ -2 to 2 ] in controls ( p<0.001 ) and self-reported adherence to pharmacological therapy was significantly higher in the school group ( 92 % ) compared to the control group ( 80 % ) , p<0.001 . CONCLUSION The programme increased knowledge about osteoporosis and increased self-reported adherence to pharmacological treatment over a period of two years Introduction Osteoporosis represents a growing public health concern ; however , current rates of management are sub-optimal . The aim of our study was to assess , in a r and omized controlled trial , the effect of a mailed educational intervention on older adults ’ knowledge , attitudes , and preventive behaviors regarding osteoporosis . The setting was a large publicly funded state pharmacy benefits program . The patients were 31,715 Medicare beneficiaries from Pennsylvania who participated in a drug benefits program for low-to-moderate income elderly people . Methods All women aged over 65 years , and all men and women with a history of fracture or long-term oral use of glucocorticoid , were included . Approximately half of the participants ( intervention group ) were r and omly selected to receive three mailings aim ed at improving knowledge of osteoporosis and enhancing preventive activities , such as using calcium and vitamin D , reducing fall risks in the home , obtaining a bone mineral density ( BMD ) test , and taking medications when necessary . The other participants did not receive the intervention mailings and served as controls . We surveyed a sample of intervention and control subjects to determine the effects of the intervention on knowledge , attitudes , self-efficacy ( confidence in one ’s ability to perform specific activities ) , and behavior regarding osteoporosis prevention and treatment . Six hundred r and omly selected participants in the intervention group and an equal number in the control group were invited to participate . Results Twenty-six had died and 636 of the remaining 1,185 ( 54 % ) completed the survey . Respondents and non-respondents did not differ significantly with respect to measured sociodemographic factors . All scales had good reliability ( all Cronbach ’s alphas > 0.65 ) . Knowledge of osteoporosis was generally very good and did not differ between intervention ( mean = 65 % correct responses ) and control subjects ( mean = 67 % correct ; P=0.4 ) . Perceived susceptibility to osteoporosis was relatively high and similar across groups ( P=0.4 ) . Self-efficacy for participating in osteoporosis prevention and treatment was very strong in both the intervention ( mean = 4.3 on a 0–5 scale ) and control ( mean = 4.2 , P=0.03 ) groups . On average , subjects in the intervention group reported participating in 3.5 of 6 preventive osteoporosis activities compared with 3.4 in the control group ( P=0.5 ) . Conclusions Compared with the controls , a mailed educational intervention for osteoporosis was not associated with better knowledge , higher perceived susceptibility , or performance of preventive measures among the at-risk older adults that we studied . The intervention group demonstrated a small increase in self-efficacy . More intensive patient interventions or intervention aim ed at other aspects of the care process may be required to bring about changes that lead to a reduction in fractures Background Bisphosphonates can reduce fracture risk in patients with osteoporosis , but many at-risk patients do not start or adhere to these medications . The aims of this study are to : ( 1 ) preliminarily evaluate the effect of an individualized 10-year osteoporotic fracture risk calculator and decision aid ( OSTEOPOROSIS CHOICE ) for postmenopausal women at risk for osteoporotic fractures ; and ( 2 ) assess the feasibility and validity ( i.e. , absence of contamination ) of patient-level r and omization ( vs. cluster r and omization ) in pilot trials of decision aid efficacy . Methods / Design This is a protocol for a parallel , 2-arm , r and omized trial to compare an intervention group receiving OSTEOPOROSIS CHOICE to a control group receiving usual primary care .  Postmenopausal women with bone mineral density T-scores of < -1.0 , not receiving bisphosphonate therapy , and receiving care at participating primary care practice s in and around Rochester , Minnesota , USA will be eligible to participate in the trial . We will measure the effect of OSTEOPOROSIS CHOICE on five outcomes : ( a ) patient knowledge regarding osteoporosis risk factors and treatment ; ( b ) quality of the decision-making process for both the patient and clinician ; ( c ) patient and clinician acceptability and satisfaction with the decision aid ; ( d ) rate of bisphosphonate use and adherence , and ( e ) trial processes ( e.g. , ability to recruit participants , collect patient outcomes ) . To capture these outcomes , we will use patient and clinician surveys following each visit and video recordings of the clinical encounters . These video recordings will also allow us to determine the extent to which clinicians previously exposed to the decision aid were able to recreate elements of the decision aid with control patients ( i.e. , contamination ) . Pharmacy prescription profiles and follow-up phone interviews will assess medication start and adherence at 6 months . Discussion This pilot trial will provide evidence of feasibility , validity of patient r and omization , and preliminary efficacy of a novel approach -- decision aids -- to improving medication adherence for postmenopausal women at risk of osteoporotic fractures . The results will inform the design of a larger trial that could provide more precise estimates of the efficacy of the decision aid . Trial registration Clinical Trials.gov Identifier : Summary Osteoporosis treatment has low adherence and persistence . This study evaluated if greater patient involvement could improve them . At 12 months , only 114 out of 344 participants were “ fully adherent and persistent ” ( all drug doses taken throughout the study ) . Only frequency of drug administration had a significant influence on adherence . Introduction Osteoporosis affects millions of individuals worldwide . There are now several effective drugs , but adherence to and persistence with treatment are low . This 12-month multicenter , prospect i ve , r and omized study evaluated the efficacy of two different methods aim ed at improving adherence and persistence through greater patient involvement , compared with st and ard clinical practice . Methods Three hundred thirty-four post-menopausal women , receiving an oral prescription for osteoporosis for the first time , were recruited and r and omized into three groups : group 1 ( controls , managed according to st and ard clinical practice ) and groups 2 and 3 ( managed with greater patient and caregiver involvement and special reinforcements : group 2 , instructed to use several different “ reminders ” ; group 3 , same “ reminders ” as group 2 , plus regular phone calls from and meetings at the referring Center ) . All enrolled women had two visits ( baseline and 12 months ) . Results Of 334 enrolled women , 247 ( 74 % ) started the prescribed therapy . Of those who started , 219 ( 88.7 % ) persisted in therapy for at least 10 months . At final evaluation , only 114 women were considered as “ fully adherent and persistent ” ( all doses taken throughout the 12 months ) . There were no significant differences regarding “ full adherence ” among the three r and omized groups . The frequency of drug administration had a significant influence : weekly administration had a > 5-fold higher adherence and monthly administration an 8-fold higher adherence ( p < 0.0001 ) than daily administration . Conclusions The special effort of devising and providing additional reminders did not prove effective . Additional interventions during the follow-up , including costly interventions such as phone calls and educational meetings , did not provide significant advantages Objective To evaluate the effectiveness of an educational video on osteoporosis at increasing knowledge and preventive health behaviors . Design A total of 195 women between 35 and 80 years of age without documented osteopenia or osteoporosis , who presented for a gynecological examination in an outpatient setting , were enrolled . Of this number , 98 women were r and omly assigned to the intervention group that viewed the video before their office visit , and 97 women were assigned to a control group and saw their physician in a routine manner . After their visit , all participants answered a question naire that assessed their knowledge of osteoporosis and baseline health-related behaviors . Three months later , a follow-up question naire was mailed to participants , eliciting whether preventive behavior had commenced . Frequencies were compared using the Fisher exact test ( 2-tailed ) . Continuous variables were analyzed using the Student 's t test . Results The two groups had no statistically significant differences in demographics . The intervention group scored a mean of 92 % compared with a mean of 80 % in the control group on the initial osteoporosis assessment question naire ( P < 0.001 ) . The 3-month follow-up question naire demonstrated that significantly more women in the intervention group started taking calcium supplements  ( 26.5 % v 4.9 % ; P < 0.001 ) , started taking vitamin D supplements  ( 20.6 % v 6.6 % ; P = 0.02 ) , started a  program of weight-bearing exercise  ( 13.3 % v 1.7 % ; P = 0.03 ) , and started  hormone therapy ( 8 % v 1 % ; P = 0.04 ) . Conclusion The use of an educational video on osteoporosis seems to improve patient knowledge and may positively impact health-related behaviors Summary Osteoporosis is an increasing burden on individuals and health re sources . The Osteoporosis Prevention and Self-Management Course ( OPSMC ) was design ed to assist individuals to prevent and manage osteoporosis ; however , it had not been evaluated in an Australian setting . This r and omised controlled trial showed that the course increased osteoporosis knowledge . Introduction and hypothesisOsteoporosis is a major and growing public health concern . An OPSMC was design ed to provide individuals with information and skills to prevent or manage osteoporosis , but its effectiveness has not previously been evaluated . This study aim ed to determine whether OPSMC attendance improved osteoporosis knowledge , self-efficacy , self-management skills or behaviour . Material s and methods Using a wait list r and omised controlled trial design , 198 people ( 92 % female ) recruited from the community and aged over 40 ( mean age = 63 ) were r and omised into control ( n = 95 ) and intervention ( n = 103 ) groups . The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators . The primary outcome were osteoporosis knowledge , health-directed behaviour , self-monitoring and insight and self-efficacy . Results The groups were comparable at baseline . At 6-week follow-up , the intervention group showed a significant increase in osteoporosis knowledge compared with the control group ; mean change 3.5 ( p < 0.001 ) on a measure of 0–20 . The intervention group also demonstrated a larger increase in health-directed behaviour , mean change 0.16 ( p < 0.05 ) , on a measure of 0–6 . Conclusion The results indicate that the OPSMC is an effective intervention for improving underst and ing of osteoporosis and some aspects of behaviour in the short term Summary We tested the feasibility of a fracture prevention decision aid in an online patient portal . The decision aid was acceptable for patients and successfully decreased decisional conflict . This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care . Introduction Although interventions have improved osteoporosis screening and /or treatment for certain population s of high-risk patients , recent national studies suggest that large-scale uptake of these interventions has been limited . We aim ed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid ( DA ) . Methods We conducted a pilot r and omized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of < −1 . Intervention subjects were provided a link to a patient DA . The DA contained a 10-year fracture risk calculator , summary of medication risks and benefits ( prescription and nonprescription ) , and an elicitation of values . Subjects completed question naires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial . Charts were review ed for physician-subject interactions and medication uptake . Results The DA was acceptable to subjects , but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator . Decisional conflict was lower post-intervention for those who were r and omized to the decision aid arm compared to controls ( 17.8 vs. 47.1 , p < .001 ) , and there was a significant difference in the percentage of patients who made a treatment decision at 3 months . No significant differences were observed in medication uptake . Conclusions A portal-based osteoporosis DA  was acceptable and improved several measures of decision quality . Given its effect on improving the quality of patients ’ decisions , future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients Summary We have design ed an innovative r and omized controlled trial for improving adherence with osteoporosis medications . Recruitment and r and omization have been successful . Also , the counseling intervention has been well accepted by subjects r and omized to this treatment arm . Introduction While many effective treatments exist for osteoporosis , most people do not adhere to such treatments long term . No proven interventions exist to improve osteoporosis medication adherence . We report here on the design and initial enrollment in an innovative r and omized controlled trial aim ed at improving adherence to osteoporosis treatments . Methods The trial represents a collaboration between academic research ers and a state-run pharmacy benefits program for low-income older adults . Beneficiaries beginning treatment with a medication for osteoporosis are targeted for recruitment . We r and omize consenting individuals to receive 12 months of mailed education ( control arm ) or an intervention consisting of one-on-one telephone-based counseling and the mailed education . Motivational interviewing forms the basis for the counseling program which is delivered by seven trained and supervised health counselors over ten telephone calls . The counseling sessions include scripted dialog and open-ended questions about medication adherence and its barriers , as well as structured questions . The primary end point of the trial is medication adherence measured over the 12-month intervention period . Secondary end points include fractures , nursing home admissions , health care re source utilization , and mortality . Results During the first 7 months of recruitment , we have screened 3,638 potentially eligible subjects . After an initial mailing , 1,115 ( 30.6 % ) opted out of telephone recruitment and 1,019 ( 28.0 % ) could not be successfully contacted . Of the remaining , 879 ( 24.2 % ) consented to participate and were r and omized . Women comprise over 90 % of all groups ; mean ages range from 77 to 80 years old , and the majority in all groups was white . The distribution of osteoporosis medications was comparable across groups and the median number of different prescription drugs used in the prior year was eight to ten . Conclusions We have developed a novel intervention for improving osteoporosis medication adherence . The intervention is currently being tested in a large-scale r and omized controlled trial . If successful , the intervention may represent a useful model for improving adherence to other chronic treatments OBJECTIVE Poor adherence to therapy , perhaps related to unaddressed patient preferences , limits the effectiveness of osteoporosis treatment in at-risk women . A parallel patient-level r and omized trial in primary care practice s was performed . METHODS Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included . In addition to usual primary care , intervention patients received a decision aid ( a tailored pictographic 10-year fracture risk estimate , absolute risk reduction with bisphosphonates , side effects , and out-of-pocket cost ) , and control patients received a st and ard brochure .  Knowledge transfer , patient involvement in decision-making , and rates of bisphosphonate start and adherence were studied . Data came from medical records , post-visit written and 6-month phone surveys , video recordings of clinical encounters , and pharmacy prescription profiles . RESULTS A total of 100 patients ( range of 10-year fracture risk , 6%-60 % ) were allocated r and omly to receive the decision aid ( n=52 ) or usual care ( n=48 ) . Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk ( 49 % vs 28 % ; 95 % confidence interval [ CI ] , 1.03 - 3.2 ) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates ( 43 % vs 16 % ; 95 % CI , 1.3 - 5.7 ) . Patient involvement improved with the decision aid by 23 % ( 95 % CI , 13.6 - 31.4 ) .  Bisphosphonates  were started by 44 % of patients receiving the decision aid and 40 % of patients receiving usual care . Adherence at 6 months was similarly high across both groups , but the proportion with more than 80 % adherence was higher with the decision aid ( n=23 [ 100 % ] vs n=14 [ 74 % ] ; P = .009 ) . CONCLUSION A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women , did not affect start rates , and may have improved adherence Background Despite accurate diagnostic tests and effective therapies , the management of osteoporosis has been observed to be suboptimal in many setting s. We tested the effectiveness of an intervention to improve care in patients at-risk of osteoporosis . Design R and omized controlled trial . Participants Primary care physicians and their patients at-risk of osteoporosis , including women 65 years and over , men and women 45 and over with a prior fracture , and men and women 45 and over who recently used ≥90 days of oral glucocorticoids . InterventionA multifaceted program of education and reminders delivered to primary care physicians as well as mailings and automated telephone calls to patients . Outcome : Either undergoing a bone mineral density ( BMD ) testing or filling a prescription for a bone-active medication during the 10 months of follow-up . Results After the intervention , 144 ( 14 % ) patients in the intervention group and 97 ( 10 % ) patients in the control group received either a BMD test or filled a prescription for an osteoporosis medication . This represents a 4 % absolute increase and a 45 % relative increase ( 95 % confidence interval 9–93 % , p = 0.01 ) in osteoporosis management between the intervention and control groups . No differences between groups were observed in the incidence of fracture . Conclusion An intervention targeting primary care physicians and their at-risk patients increased the frequency of BMD testing and /or filling prescriptions for osteoporosis medications . However , the absolute percentage of at-risk patients receiving osteoporosis management remained low Objective To assess whether osteoporosis education , with and without bone mineral density ( BMD ) testing , increases the initiation of lifestyle changes and pharmaceutical treatment to prevent osteoporosis . Design A total of 508 women , aged 54–65 , from a large managed care organization who were not on osteoporosis prevention therapy participated in an intervention study . Participants were r and omly assigned to either an education class on osteoporosis ( n = 301 ) or education plus BMD ( n = 207 ) . A control group of 187 women receiving no intervention were also surveyed to serve as comparison . Group differences and differences based on BMD test result were compared 6 months after education regarding self-reported changes in health behaviors using & khgr;2 tests and logistic regression analyses . Results Of the 508 intervention participants , 455 ( 90 % ) responded to the follow-up survey . Initiation of hormone replacement therapy was reported by 9 % , with 5 % reporting starting alendronate . More than half reported changes in diet , exercise , or calcium intake . Forty-three percent increased their vitamin D intake . There were no significant group differences in behavior except with regard to pharmaceutical therapy ; subjects with education plus BMD were three times more likely than those receiving education only to report starting hormone replacement therapy ( p = 0.004 ) . Low BMD scores were associated with increasing vitamin D intake ( p = 0.03 ) and starting medication ( p = 0.001 ) . Women in the intervention groups were significantly more likely to report modifying their diet ( p < 0.001 ) , calcium ( p < 0.01 ) , and vitamin D intake ( p < 0.0001 ) than women in the control group , not exposed to education . Conclusion Education regarding osteoporosis prevention seems to encourage women to make lifestyle changes . The inclusion of BMD testing enhances the likelihood that women will consider pharmaceutical therapy BACKGROUND Academic detailing utilizes educators trained in social marketing to conduct one-on-one visits with physicians using evidence -based data . Academic detailing programs have improved physician 's prescribing behaviors ; however , the feasibility of large-scale programs across a large , geographically disperse state is unclear . METHODS The study team collaborated with a state-run pharmacy benefits program for low-income elderly in a trial to improve osteoporosis management . Community-practicing physicians who saw a minimum of 25 patients enrolled in the benefits program were r and omized to receive academic detailing or not . Fourteen educators were trained in the principles of academic detailing as well as osteoporosis epidemiology , diagnosis , and treatment . From September 2003 to January 2004 , they attempted to meet with physicians or an allied health professional to discuss osteoporosis and fracture prevention . RESULTS The physician population was 356 and 148 ( 41.6 % ) visits were completed-100 with physicians , 38 with allied health professionals , and 10 with both the physician and an allied health professional . In mixed multivariable models , there were no physician characteristics associated with completed encounters , including gender , training , geographic location , years since medical school , and number of study patients ( all p-values > 0.11 ) . The detailer 's gender , professional training , and professional experience were not statistically significant correlates of completed encounters ( all p-values > 0.28 ) . Number of years since a detailer 's professional training was a predictor of a completed encounter , OR = 1.43 per 5 years ( 95%CI 1.05 , 1.96 ) . CONCLUSIONS A moderate rate of completed encounters was achieved . There was only one predictor of completed encounters UNLABELLED We conducted a r and omized controlled trial within the setting of a large drug benefit plan for Medicare beneficiaries . Primary care physicians and their patients were r and omized to usual care , patient intervention only , physician intervention only , or both interventions . There was no difference in the probability of the primary composite endpoint ( BMD test or osteoporosis medication ) or in either of its components comparing the combined intervention group with usual care ( risk ratio = 1.04 ; 95 % CI , 0.85 - 1.26 ) . INTRODUCTION Fractures from osteoporosis are associated with substantial morbidity , mortality , and cost . However , only a minority of at-risk older adults receives screening and /or treatment for this condition . We evaluated the effect of educational interventions for osteoporosis targeting at-risk patients , primary care physicians , or both . MATERIAL S AND METHODS We conducted a r and omized controlled trial within the setting of a large drug benefit plan for Medicare beneficiaries . Primary care physicians and their patients were r and omized to usual care , patient intervention only , physician intervention only , or both interventions .  The at-risk patients were women > or=65 yr of age , men and women > or=65 yr of age with a prior fracture , and men and women > or=65 yr of age who used oral glucocorticoids .  The primary outcome studied was a composite of either undergoing a BMD test or initiating a medication used for osteoporosis . The secondary outcome was a hip , humerus , spine , or wrist fracture . RESULTS We r and omized 828 primary care physicians and their 13,455 eligible at-risk patients into four study arms . Physician and patient characteristics were very similar across all four groups . Across all four groups , the rate of the composite outcome was 10.3 per 100 person-years and did not differ between the usual care and the combined intervention groups ( p = 0.5 ) . In adjusted Cox proportional hazards models , there was no difference in the probability of the primary composite endpoint comparing the combined intervention group with usual care ( risk ratio = 1.04 ; 95 % CI , 0.85 - 1.26 ) . There was also no difference in either of the components of the composite endpoint . The probability of fracture during follow-up was 4.2 per 100 person-years and did not differ by treatment assignment ( p = 0.9 ) . CONCLUSIONS In this trial , a relatively brief program of patient and /or physician education did not work to improve the management of osteoporosis . More intensive efforts should be considered for future quality improvement programs for osteoporosis Background Osteoporosis-related fractures are a significant public health concern . Interventions that increase detection and treatment of osteoporosis are underutilized . This pragmatic r and omised study was done to evaluate the impact of a multifaceted community-based care program aim ed at optimizing evidence -based management in patients at risk for osteoporosis and fractures . Methods This was a 12-month r and omized trial performed in Ontario , Canada . Eligible patients were community-dwelling , aged ≥55 years , and identified to be at risk for osteoporosis-related fractures . Two hundred and one patients were allocated to the intervention group or to usual care . Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing , patient education and patient-specific recommendations for osteoporosis treatment . The primary outcome was the implementation of appropriate osteoporosis management . Results 101 patients were allocated to intervention and 100 to control . Mean age of participants was 71.9 ± 7.2 years and 94 % were women . Pharmacological treatment ( alendronate , risedronate , or raloxifene ) for osteoporosis was increased by 29 % compared to usual care ( 56 % [ 29/52 ] vs. 27 % [ 16/60 ] ; relative risk [ RR ] 2.09 , 95 % confidence interval [ CI ] 1.29 to 3.40 ) . More individuals in the intervention group were taking calcium ( 54 % [ 54/101 ] vs. 20 % [ 20/100 ] ; RR 2.67 , 95 % CI 1.74 to 4.12 ) and vitamin D ( 33 % [ 33/101 ] vs. 20 % [ 20/100 ] ; RR 1.63 , 95 % CI 1.01 to 2.65 ) . Conclusions A multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care . Trial Registration This trial has been registered with clinical trials.gov ( ID : NCT00465387 Background This study describes the analysis of secondary outcomes from a previously published r and omised controlled trial , which assessed the effects of pharmaceutical care on medication adherence , persistence and bone turnover markers . The main focus of this manuscript is the effect of the provision of pharmaceutical care on these secondary outcomes , and details on the design of the intervention provided , the osteoporosis care plan and material s used to deliver the intervention . Objectives To evaluate the effects of pharmaceutical care on knowledge , quality of life ( QOL ) and satisfaction of postmenopausal osteoporotic women prescribed bisphosphonates , and their associating factors . Setting R and omised controlled trial , performed at an osteoporosis clinic of a tertiary hospital in Malaysia . Methods Postmenopausal women diagnosed with osteoporosis ( T-score ≤−2.5/lowtrauma fracture ) , just been prescribed weekly alendronate/risedronate  were r and omly allocated to receive intervention or st and ard care ( controls ) . Intervention participants received a medication review , education on osteoporosis , risk factors , lifestyle modifications , goals of therapy , side effects and the importance of medication adherence at months 0 , 3 , 6 and 12 . Main outcomes measure Knowledge , QOL and satisfaction . Results A total of 198 postmenopausal osteoporotic women were recruited : intervention = 100 and control = 98 . Intervention participants reported significantly higher knowledge scores at months 3 ( 72.50 vs. 62.50 % ) , 6 ( 75.00 vs. 65.00 % ) and 12 ( 78.75 vs. 68.75 % ) compared to control participants . QOL scores were also lower ( which indicates better QOL ) at months 3 ( 29.33 vs. 38.41 ) , 6 ( 27.50 vs. 36.56 ) and 12 ( 27.53 vs. 37.56 ) compared to control participants . Similarly , satisfaction score was higher in intervention participants ( 93.67 vs. 84.83 % ) . More educated women , with back pain , who were provided pharmaceutical care had better knowledge levels . Similarly , older , more educated women , with previous falls and back pain tend to have poorer QOL , whilst women who exercised more frequently and were provided pharmaceutical care had better QOL . Satisfaction also increased as QOL increases and when provided pharmaceutical care . Conclusion The provision of pharmaceutical care improved knowledge , QOL and satisfaction in Malaysian postmenopausal osteoporotic women , showing that pharmacists have the potential to improve patients ’ overall bone health . Policymakers should consider placing a clinical pharmacist in the osteoporosis clinic to provide counselling to improve these outcomes In this 2-yr r and omized controlled trial , we examined the effect of bone mineral density feedback and two different educational interventions ( an osteoporosis information leaflet and group-based behavioral education [ OPSMC ] ) on osteoporosis knowledge and self-efficacy in 470 women aged 25 - 44 yr .  Osteoporosis knowledge increased across all intervention groups . Women receiving the OPSMC had a greater increase in both short ( beta = + 1.33 , 95 % confidence interval [ CI ] = 0.72 - 1.94 ) and long-term ( beta = + 0.64 , 95 % CI = 0.0034 - 1.25 ) osteoporosis knowledge , compared to those receiving the leaflet . In contrast , a low T-score was associated with a significant increase in long-term ( beta = + 0.66 , 95 % CI = 0.0034 - 1.25 ) but not short-term ( beta = + 0.57 , 95 % CI = -0.036 to 1.17 ) osteoporosis knowledge , compared to a normal T-score . Changes in osteoporosis self-efficacy were not associated with either low bone mineral density or receiving the OPSMC but were negatively associated with number of children ( beta = -0.9 , 95 % CI = - 1.4 to -0.3 ) and working more than 20 h per week ( beta = -2.7 , 95 % CI = -4.6 to -0.8 ) . In conclusion , both the OPSMC and bone density feedback increased osteoporosis knowledge but not self-efficacy over 2 yr . Women with children or who worked full time have decreased osteoporosis self-efficacy , suggesting that this group should be a specific target for future interventional strategies
Conclusions This review indicates that it is still unclear whether patient education is beneficial and whether it has a significant and clinical ly relevant impact on osteoporosis management results .
Summary This review summarizes evidence regarding the effects of patient education in osteoporosis prevention and treatment .
Method ological improvem ent of future RCTs ( e.g. with regard to r and omization and duration of follow-up ) might yield more conclusive evidence on the effects of patient education in osteoporosis Introduction This review aims to evaluate the effects of patient education on osteoporosis prevention and treatment results .