A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial Improving compliance to osteoporosis workup and treatment in postmenopausal patients after a distal radius fracture. A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal Community based intervention to optimize osteoporosis management: randomized controlled trial Cohort profile: research on Osteoarthritis/Osteoporosis Against Disability study. The impact of osteoporosis on quality-of-life: the OFELY cohort. Osteoporosis among older Saudis: risk of fractures and unmet needs Osteoporosis action: design of the healthy bones project trial. Facilitated bone mineral density testing versus hospital-based case management to improve osteoporosis treatment for hip fracture patients: additional results from a randomized trial. Community-based randomised controlled trial evaluating falls and osteoporosis risk management strategies A randomized controlled trial of mailed osteoporosis education to older adults Multimodal intervention to improve osteoporosis care in home health settings: results from a cluster randomized trial A Clinical Decision Support System for the Diagnosis, Fracture Risks and Treatment of Osteoporosis An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial. Evaluation of a Nationwide Pharmacist-Led Phone Outreach Program to Improve Osteoporosis Management in Older Women with Recently Sustained Fractures.
Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems , yet gaps in management still exist . In response , we developed a multi-component osteoporosis knowledge translation ( Op-KT ) tool involving a patient-initiated risk assessment question naire ( RAQ ) , which generates individualized best practice recommendations for physicians and customized education for patients at the point of care . The objective of this study was to evaluate the effectiveness of the Op-KT tool  for appropriate disease management by physicians . Methods The Op-KT tool was evaluated using an interrupted time series design . This involved multiple assessment s of the outcomes 12 months before ( baseline ) and 12 months after tool implementation ( 52 data points in total ) . Inclusion criteria were family physicians and their patients at risk for osteoporosis ( women aged ≥50 years , men aged ≥65 years ) . Primary outcomes were the initiation of appropriate osteoporosis screening and treatment . Analyses included segmented linear regression modeling and analysis of variance . Results The Op-KT tool was implemented in three family practice s in Ontario , Canada representing 5 family physicians with 2840 age eligible patients ( mean age 67 years ; 76 % women ) . Time series regression models showed an overall increase from baseline in the initiation of screening ( 3.4 % ; P < 0.001 ) , any osteoporosis medications ( 0.5 % ; P = 0.006 ) , and calcium or vitamin D ( 1.2 % ; P = 0.001 ) . Improvements were also observed at site level for all the three sites considered , but these results varied across the sites . Of 351 patients who completed the RAQ unprompted ( mean age 64 years , 77 % women ) , the mean time for completing the RAQ was 3.43 minutes , and 56 % had any disease management addressed by their physician . Study limitations included the inherent susceptibility of our design compared with a r and omized trial . Conclusions The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practice s , and highlights its potential to facilitate patient self-management . Next steps include wider implementation and evaluation of the tool in primary care 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 OBJECTIVE Distal radius fracture ( DRF ) in postmenopausal women is often the first clinical sign of osteoporosis ( OP ) . Despite the availability of effective treatments , only a minority of patients who sustain a fragility fracture are tested for OP . The purpose of this study was to examine whether a simple intervention by the hospital staff increases rates of OP workup . MATERIAL S AND METHODS We conducted a prospect i ve r and omized clinical trial . Ninety nine patients after DRF were r and omized to two groups . Both groups were contacted after their fracture and were asked to answer a question naire and were informed about the possible relationship between DRF and OP . In the intervention group , patients were sent an explanatory pamphlet and a letter to their primary care physician . An additional survey was conducted to establish whether the intervention improved the number of patients who undergo OP workup . RESULTS The intervention increased the proportion of patients who turned to their primary care physician from 22.9 % to 68.6 % , and increased the proportion of patients undergoing OP workup from 14.3 % to 40 % ( p < 0.001 ) . CONCLUSION Women with DRF who receive an explanation about possible OP implication s and are sent explanatory material s are more likely to undergo OP workup 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 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 Since the proportion of the ageing population in Japan is increasing , a comprehensive and evidence based strategy is urgently required for the prevention of musculoskeletal diseases , including osteoarthritis ( OA ) and osteoporosis ( OP ) , both of which affect the activities of daily living ( ADL ) and quality of life ( QOL ) and increase morbidity and mortality . However , few prospect i ve , longitudinal studies for the purpose of developing such a strategy have been conducted , and little information is available regarding the prevalence and incidence of musculoskeletal disorders , including OA and OP , as well as pain and disability in the Japanese population . It is difficult to design rational clinical and public health approaches for the diagnosis , evaluation and prevention of OA and OP without such epidemiological data . The Research on Osteoarthritis/osteoporosis Against Disability ( ROAD ) study was established in 2005 by N.Y. , T.A. , H.O. , S.M. , H.K. and K.N. ( principal investigators ) . The principal investigators are affiliated with the 22nd Century Medical and Research Center , University of Tokyo Although the long-term outcomes of osteoporosis ( Op ) such as fracture , kyphosis , and pain are well known , the physical , psychological , and social consequences , beyond fracture and pain , are less clear . The Osteoporosis-targeted Quality -of-life ( OPTQoL ) question naire aim ed at assessing the physical difficulty , fears , and adaptations to one 's daily life was developed as a cross-sectional instrument to characterize the burden of Op within a community . The purpose of this study was to assess the impact of Op and related factors on community women participating in the OFELY study in France .  Femoral neck bone mineral density ( BMD ) and  OPTQoL question  naire data were collected from women r and omly selected from a large insurance company . Data were obtained for 756 women ( mean age 59 years , range 36 - 92 ) , most of whom were white . Women were classified into five groups based on the extent of physical manifestations and family history of Op . Women who had prior fractures , height loss , and /or kyphosis or both reported greater physical difficulty , more adaptations to their lives , and greater fears than women reporting no such changes . Scores on the Physical Difficulty domain , however , did not differ significantly based on BMD alone ( BMD T score < or=2.5 ) , after controlling for age and self-reported arthritis . The negative impact of Op on quality -of-life ( QoL ) seems to be more related to the physical manifestations of Op than to bone density levels . Recognition of the impact of Op-related factors on QoL may help health-care providers more fully appreciate the importance of prevention and treatment Summary Using FRAX ® , this study aim ed at estimating 10-years probability of osteoporosis (OP)-related fractures and identifies those in need of OP treatment among primary care attendees in Saudi Arabia . Of those aged ≥ 60 years , 14.4 and 18.4 % scored probabilities for major and hip fractures respectively suggesting OP treatment . Predictors for receiving OP screening included the presence of multiple clinical risk factors , occurrence of fragility fractures and physicians recommendation . Purpose This study aim ed at estimating the 10-years probability of osteoporosis (OP)-related fractures and identifying those in need of OP treatment among Saudi adults attending primary care centers ( PHCs ) in Al Hassa , Saudi Arabia , using FRAX ® calculator and to determine factors possibly influence receiving of OP screening among them . Subjects and Methods A total of 1,251 Saudi aged ≥ 40 years , of both genders , were recruited from four urban and three rural r and omly selected PHCs . All were subjected to anthropometric measurements followed by a personal interview with structured question naire to asses OP clinical risk factors ( CRFs ) and possible correlates for receiving OP screening .  Ten-year probabilities for major osteoporotic and hip fractures were calculated using the Lebanese version of FRAX ® calculator . Results Of participants aged ≥ 60 years , 14.4 and 18.4 % were identified with probability scores for major osteoporotic and hip fractures respectively , suggesting OP treatment . Out of sample d population , 16.1 % received OP screening . The presence of ≥two OP CRFs ( odds ratio OR = 4.45 ) , being aware of OP ( OR = 2.89 ) , physician recommendation of OP screening  ( OR = 2.01 ) , and history of fragility fracture ( OR = 1.92 ) were all possible positive predictors for receiving OP screening . Conclusion A sizable portion of the sample d older Saudis especially those aged ≥ 60 years are at high risk for OP-related fractures indicative to receive OP treatment . Occurrence of fragility fractures , multiplicity of CRFs and physician ’s recommendations are significant positive predictors to receive OP screening among them Although osteoporosis is common in older adults , it is often under-diagnosed and under-treated . We developed community-based patient- and physician-directed interventions for fracture prevention and compared them in a 2 x 2 factorial r and omized controlled trial . The study population included older adults who were enrolled in a state-run pharmacy benefits program ( The Pharmaceutical Assistance Contract for the Elderly in Pennsylvania ) for Medicare beneficiaries . We r and omly assigned 826 primary care physicians and their 31,715 patients to one of four trial arms -- no patient and no physician intervention , patient but no physician intervention , physician but no patient intervention , both patient and physician interventions . The patient intervention consisted of targeted communication about fall and fracture prevention and osteoporosis diagnosis and treatment . It was delivered through several mailings . The physician intervention entailed one-on-one academic detailing encounters covering the same topics . The composite primary endpoint consisted of use of osteoporosis medication or a bone mineral density test . Other endpoints included patient 's knowledge and attitudes towards fractures and osteoporosis , use of lower extremity strengthening to prevent falls , and the occurrence of fractures . All outcomes will be analyzed using r and om effects models accounting for clustering of subjects within physicians ' practice OBJECTIVE We previously demonstrated that a case manager intervention improved  osteoporosis  ( OP ) treatment within 6 months of hip fracture compared with usual care . The second phase of the r and omized trial compared a less intensive intervention , facilitated bone mineral density ( BMD  )  testing , with usual care and the case manager intervention . METHODS We initially r and omized 220 hip fracture patients to either an OP case manager intervention or usual care . After completing the original trial at 6 months postfracture , usual care patients were reallocated to facilitated BMD testing ; BMD tests were arranged and results sent to primary care physicians . Main outcomes ( bisphosphonate treatment , BMD tests , receipt of appropriate care ) were reascertained 1 year following hip fracture and compared with outcomes achieved by the OP case manager intervention and usual care . RESULTS Compared with usual care , facilitated BMD testing increased testing from 29 % to 68 % ( P < 0.001 ) , bisphosphonate use from 22 % to 38 % ( P < 0.001 ) , and receipt of appropriate care from 26 % to 45 % ( P < 0.001 ) . The more intensive ( 70 versus 30 minutes ) and expensive ( $ 56 versus $ 24 Canadian per patient ) OP case manager intervention led to significantly higher bisphosphonate use ( 54 % versus 38 % ; P = 0.03 ) , receipt of appropriate care ( 71 % versus 45 % ; P < 0.001 ) , and more BMD testing ( 80 % versus 68 % ; P = 0.06 ) than usual care followed by facilitated BMD testing . CONCLUSION Compared with usual care , 2 different inexpensive interventions result ed in significant increases in appropriate management of OP after hip fracture . The magnitude of improvements achieved was directly related to the intensity of the interventions Background Osteoporosis-related fractures are a significant public health concern . Interventions that increase detection and treatment of osteoporosis , as well as prevention of fractures and falls , are substantially underutilized . This paper outlines the protocol for a pragmatic r and omised trial of a multifaceted community-based care program aim ed at optimizing the evidence -based management of falls and fractures in patients at risk . Design 6-month r and omised controlled study . Methods This population -based study was completed in the Algoma District of Ontario , Canada a geographically vast area with Sault Ste Marie ( population 78 000 ) as its main city . Eligible patients were allocated to an immediate intervention protocol ( IP ) group , or a delayed intervention protocol ( DP ) group  . The DP group received usual care for 6 months and then was crossed over to receive the interventions . Components of the intervention were directed at the physicians and their patients and included patient-specific recommendations for osteoporosis therapy as outlined by the clinical practice guidelines developed by Osteoporosis Canada , and falls risk assessment and treatment . Two primary outcomes were measured including implementation of appropriate osteoporosis and falls risk management . Secondary outcomes included quality of life and the number of falls , fractures , and hospital admissions over a twelve-month period . The patient is the unit of allocation and analysis . Analyses will be performed on an intention to treat basis . Discussion This paper outlines the protocol for a pragmatic r and omised trial of a multi-faceted , community-based intervention to optimize the implementation of evidence based management for patients at risk for falls and osteoporosis . Trial Registration This trial has been registered with clinical trials.gov ( ID : NCT00465387 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 Summary We conducted a cluster r and omized trial testing the effectiveness of an intervention to increase the use of osteoporosis medications in high-risk patients receiving home health care . The trial did not find a significant difference in medication use in the intervention arm . Introduction This study aims to test an evidence implementation intervention to improve the quality of care in the home health care setting for patients at high risk for fractures . Methods We conducted a cluster r and omized trial of a multimodal intervention targeted at home care for high-risk patients ( prior fracture or physician-diagnosed osteoporosis ) receiving care in a statewide home health agency in Alabama . Offices throughout the state were r and omized to receive the intervention or to usual care . The primary outcome was the proportion of high-risk home health patients treated with osteoporosis medications . A t test of difference in proportions was conducted between intervention and control arms and constituted the primary analysis . Secondary analyses included logistic regression estimating the effect of individual patients being treated in an intervention arm office on the likelihood of a patient receiving osteoporosis medications . A follow-on analysis examined the effect of an automated alert built into the electronic medical record that prompted the home health care nurses to deploy the intervention for high-risk patients using a pre – post design . Results There were 11 offices r and omized to each of the treatment and control arms ; these offices treated 337 and 330 eligible patients , respectively . Among the offices in the intervention arm , the average proportion of eligible patients receiving osteoporosis medications post-intervention was 19.1 % , compared with 15.7 % in the usual care arm ( difference in proportions 3.4 % , 95 % CI , −2.6 to 9.5 % ) . The overall rates of osteoporosis medication use increased from 14.8 % prior to activation of the automated alert to 17.6 % afterward , a nonsignificant difference . Conclusions The home health intervention did not result in a significant improvement in use of osteoporosis medications in high-risk patients Exp and ing medical knowledge increases the potential risk of medical errors in clinical practice . We present , OPAD , a clinical decision support system in the field of the medical care of osteoporosis . We utilize clinical information from international guidelines and experts in the field of osteoporosis . Physicians are provided with user interface to insert st and ard patient data , from which OPAD provides instant diagnostic comments , 10-year risk of fragility fracture , treatment options for the given case , and when to offer a follow-up DXA-evaluation . Thus , the medical decision making is st and ardized according to the best expert knowledge at any given time . OPAD was evaluated in a set of 308 r and omly selected individuals .  OPAD 's ten-year fracture risk computation is nearly identical to FRAX ( r = 0.988 ) . In 58 % of cases OPAD recommended DXA evaluation  at the present time . Following a DXA measurement in all individuals , 71 % of those that were recommended to have DXA at the present time received recommendation for further investigation or specific treatment by the OPAD . In only 5.9 % of individuals in which DXA was not recommended , the result of the BMD measurement changed the recommendations given by OPAD Background Knowledge translation ( KT ) research in long-term care ( LTC ) is still in its early stages . This protocol describes the evaluation of a multifaceted , interdisciplinary KT intervention aim ed at integrating evidence -based osteoporosis and fracture prevention strategies into LTC care processes . Methods and design The Vitamin D and Osteoporosis Study ( ViDOS ) is underway in 40 LTC homes ( n = 19 intervention , n = 21 control ) across Ontario , Canada . The primary objectives of this study are to assess the feasibility of delivering the KT intervention , and clinical ly , to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily . Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician . The target audience within each LTC home is the Professional Advisory Committee ( PAC ) , an interdisciplinary team who meets quarterly . The key elements of the intervention are three interactive educational sessions led by an expert opinion leader , action planning using a quality improvement cycle , audit and feedback reports , nominated internal champions , and reminders/point-of-care tools . Control homes do not receive any intervention , however both intervention and control homes received educational material s as part of the Ontario Osteoporosis Strategy . Primary outcomes are feasibility measures ( recruitment , retention , attendance at educational sessions , action plan items identified and initiated , internal champions identified , performance reports provided and review ed ) , and vitamin D ( ≥800 IU/daily ) prescribing at 6 and 12 months . Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications , and falls and fractures . Qualitative methods will examine the experience of the LTC team with the KT intervention . Homes are central ly r and omized to intervention and control groups in blocks of variable size using a computer generated allocation sequence . R and omization is stratified by home size and profit/nonprofit status . Prescribing data retrieval and analysis are performed by blinded personnel . Discussion Our study will contribute to an improved underst and ing of the feasibility and acceptability of a multifaceted intervention aim ed at translating knowledge to LTC practitioners . Lessons learned from this study will be valuable in guiding future research and underst and ing the complexities of translating knowledge in LTC.Trial registration Clinical Trials.gov NCT01398527 BACKGROUND Multiple studies demonstrate poor adherence to medication regimens prescribed for chronic illnesses , including osteoporosis , but few interventions have been proven to enhance adherence . We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve adherence to a medication regimen for osteoporosis . METHODS We conducted a 1-year r and omized controlled clinical trial . Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries . All potentially eligible individuals had been newly prescribed a medication for osteoporosis . Consenting participants were r and omized to a program of telephone-based counseling ( n = 1046 ) using a motivational interviewing framework or a control group ( n = 1041 )  that received mailed educational material s.  Medication regimen adherence was the primary outcome compared across treatment arms and was measured as the median ( interquartile range ) medication possession ratio , calculated as the ratio of days with filled prescriptions to total days of follow-up . RESULTS The groups were balanced at baseline , with a mean age of 78 years ; 93.8 % were female . In an intention-to-treat analysis , median adherence was 49 % ( interquartile range , 7%-88 % ) in the intervention arm and 41 % ( 2%-86 % ) in the control arm ( P = .07 , Kruskal-Wallis test ) . There were no differences in self-reported fractures . CONCLUSION In this r and omized controlled trial , we did not find a statistically significant improvement in adherence to an osteoporosis medication regimen using a telephonic motivational interviewing intervention BACKGROUND Osteoporosis-related fractures are a considerable economic burden on the U.S. health care system . Since 2008 , the Centers for Medicare Medicaid Services have adopted a Medicare Part C Five-Star Quality Rating measure to ensure that a woman 's previously unaddressed osteoporosis is managed appropriately after a fracture . Despite the effort to improve this gap in care , the 2013 CMS plan ratings fact sheet reported an average star rating of 1.4 stars for the osteoporosis measure , the lowest score for any measure across all health plans . OBJECTIVE To evaluate the impact of conducting a pharmacist-led , telephone outreach program to members or their providers to improve osteoporosis management in elderly women after experiencing fractures . METHODS This was a prospect i ve , r and omized study to evaluate the effectiveness of 3 different intervention strategies within a nationwide managed care population . Women aged 66 years and older who experienced a new bone fracture between January 1 , 2012-August 31 , 2012 , were identified through medical cl aims . Women who were treated with an osteoporosis medication or received a bone mineral density ( BMD ) test within a year of their fractures were excluded . Study patients were r and omized into 3 intervention cohorts : ( 1 ) baseline intervention consisting of member educational mailing and provider educational mail or fax notification ; ( 2 ) baseline intervention plus a live outbound intervention call to members by a pharmacist ; and ( 3 ) baseline intervention plus a pharmacist call to members ' providers to recommend starting osteoporosis therapy and /or a bone mineral density ( BMD ) test . An intent-to-treat and per protocol analyses were employed , and appropriate osteoporosis management ( initiation of osteoporosis therapy and /or BMD testing ) 120 days after the baseline intervention and 180 days after a fracture were measured . RESULTS The study identified 6,591 members who were equally r and omized into 3 cohorts . The baseline demographics in each cohort were similar . Results of the intent-to-treat analysis showed more members in cohort 3 receiving appropriate osteoporosis management ( 13.0 % ) compared with those in cohort 2 ( 10.3 % , P less than 0.005 ) or compared with those in cohort 1 ( 9.1 % , P less than 0.001 ) . No difference was detected between those receiving additional member calls ( cohort 2 ) and those receiving only the baseline intervention ( cohort 1 ) . Similar results were observed utilizing the 180 days after fracture time frame . CONCLUSIONS The effectiveness of a pharmacist-led telephone intervention directed at providers or members was examined in this r and omized study . Pharmacist calls to members did not improve osteoporosis management over member and provider mail and fax notifications . Greater impact was demonstrated by performing a pharmacist call intervention with providers rather than with members
Interventions to improve OP management had a significant positive impact on prescription of BMD measurement but a more limited impact on treatment prescription
Osteoporosis ( OP ) is a major public health concern , but still OP care does not meet guidelines .
Interventions have been developed to improve appropriate OP management .
The objective of the present study was to systematic ally review the current literature to ascertain the efficacy of interventions to improve OP care and characterize interventions taking into account elements related to their potential cost and feasibility .