title: Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment Multidisciplinary patient education in groups increases knowledge on osteoporosis: A randomized controlled trial Prevalence of osteoporosis and fractures among women prescribed osteoporosis medication in five European countries: the POSSIBLE EU® study Community based intervention to optimize osteoporosis management: randomized controlled trial Efficacy of a Self-Management Program for Osteoporotic Subjects Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. What is the impact of osteoporosis education and bone mineral density testing for postmenopausal women in a managed care setting? Does an educational leaflet improve self-reported adherence to therapy in osteoporosis? The OPTIMA study Impact of the Training on the Compliance and Persistence of Weekly Bisphosphonate Treatment in Postmenopausal Osteoporosis: A Randomized Controlled Study Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial Community-based randomised controlled trial evaluating falls and osteoporosis risk management strategies Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women Patient education in groups increases knowledge of osteoporosis and adherence to treatment: a two-year randomized controlled trial. Effectiveness of Community Intervention in Improving Bone Health Behaviors in Older Adults Interventions to improve osteoporosis treatment following hip fracture. A prospective, randomized trial. Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial Changes to osteoporosis prevalence according to method of risk assessment. Low acceptance of treatment in the elderly for the secondary prevention of osteoporotic fracture in the acute rehabilitation setting Predictors of bone mineral density testing in patients at high risk of osteoporosis: secondary analyses from the OSTEOPHARM randomized trial.
abstract: Background Adherence to anti-osteoporosis treatments is poor , exposing treated women to increased fracture risk . Determinants of poor adherence are poorly understood . The study aims to determine physician- and patient- rated treatment compliance with osteoporosis treatments and to evaluate factors influencing compliance . Methods This was an observational , cross-sectional pharmacoepidemiological study with a r and omly-selected sample of 420 GPs , 154 rheumatologists and 110 gynaecologists practicing in France . Investigators included post-menopausal women with a diagnosis of osteoporosis and a treatment initiated in the previous six months . Investigators completed a question naire on clinical features , treatments and medical history , and on patient compliance . Patients completed a question naire on sociodemographic features , lifestyle , attitudes and knowledge about osteoporosis , treatment compliance , treatment satisfaction and quality of life .  Treatment compliance was evaluated with the  Morisky Medication-taking Adherence Scale . Variables collected in the question naires were evaluated for association with compliance using multivariate logistic regression analysis . Results 785 women were evaluated . Physicians considered 95.4 % of the sample to be compliant , but only 65.5 % of women considered themselves compliant . The correlation between patient and physician perceptions of compliance was low ( κ : 0.11 [ 95 % CI : 0.06 to 0.16 ] ) . Patient-rated compliance was highest for monthly bisphosphonates ( 79.7 % ) and lowest for hormone substitution therapy ( 50.0 % ) . Six variables were associated with compliance : treatment administration frequency , perceptions of long-term treatment acceptability , perceptions of health consequences of osteoporosis , perceptions of knowledge about osteoporosis , exercise and mental quality of life . Conclusion Compliance to anti-osteoporosis treatments is poor . Reduction of dosing regimen frequency and patient education may be useful ways of improving compliance 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 Summary European observational 1-year study assessed osteoporosis and fracture patterns in 3,402 postmenopausal women prescribed osteoporosis medication .  Almost 40 % of patients had a previous fracture , while 25 % had neither fracture nor dual energy X-ray absorptiometry ( DXA ) diagnosis and were prescribed medication , probably due to other risk factors . Introduction This analysis assessed osteoporosis and fracture prevalence in postmenopausal women prescribed osteoporosis treatment in the Prospect i ve Observational Study Investigating Bone Loss Experience in Europe(POSSIBLE EU ® ) . Methods Women in this observational , multicenter 1-year study were categorized by fracture history and location at baseline . Baseline characteristics were analyzed according to no DXA and DXA diagnosis ( osteoporosis or osteopenia ) . Fractures occurring during the 1-year follow-up period were recorded . Results Of the 3,402 women enrolled , 39 % had a previous fracture , of whom 30 % had ≥2 fractures . One thous and seven hundred and eighty-four ( 52 % ) patients had a DXA diagnosis ( osteoporosis 68 % , osteopenia 31 % , and unknown 1 % ) . Among the osteoporosis patients , 37 % had a previous fracture ( hip 2.9 % , vertebral 8.8 % , and non-hip , non-vertebral 25 % ) and 35 % had fractures associated with major trauma . Of the 3,402 women , 1,476 ( 43 % ) had no DXA diagnosis ; of these , 57 % had no fracture ( 25 % of all women ) . Risk factors varied across patients with and without DXA diagnosis . During the 1-year follow-up period , the fracture incidence in patients with or without a previous fracture at baseline was 4.7 % and 1.6 % , respectively . Conclusion Almost 40 % of patients prescribed osteoporosis medication had a previous fracture , highlighting a population with advanced disease . In contrast , 25 % of patients had neither a previous fracture nor DXA diagnosis and were prescribed treatment , probably due to other risk factors . There is a need for continued improvement of disease management in European women 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 Alp A , Kanat E , Yurtkuran M : Efficacy of a self-management program for osteoporotic subjects . Am J Phys Med Rehabil 2007;86:633–640 . Objective : This study is based on whether the self-management program choices For Better Bone Health is effective to promote behavioral strategies for improving bone health , life quality , pain perception , physical function , and balance in osteoporotic subjects . Design : In this single-blind , r and omized controlled study , a total of 50 sedentary women with postmenopausal and idiopathic osteoporosis were selected from the out patients of Atatürk Balneotherapy and Rehabilitation Center according to their physical activity level and T scores of dual-energy x-ray absorptiometry as the inclusion criteria . Fifty sedentary women with BMD T scores of −2.5 or lower were r and omized into two groups ( self-management group : group 1 ; and control group : group 2 ) and enrolled in a 6-mo study . Participants attended self-management class once a week for 5 wks . Evaluations were done at baseline , at the end of the fifth week , and at the sixth month . Pain-intensity evaluation by Visual Analogue Scale ( VAS ) , life- quality assessment s by SF-36 , balance testing by Sensitized Romberg Test ( SRT ) , and functional assessment by Timed Sit to St and test ( TSS ) and a simple question naire were the outcome measures . Results : When the groups were compared by change scores and percentages of change , improvements observed in pain intensity by VAS ( P < 0.001 ) , SF-36 Physical Function ( P < 0.001 ) , SF-36 Physical Role Limitations ( P < 0.001 ) , SF-36 Social Function ( P < 0.001 ) , SF-36 Mental Health ( P < 0.001 ) , SF-36 Vitality ( P < 0.01 ) , SF-36 Pain ( P < 0.001 ) , SF-36 General Health Perceptions ( P < 0.05 ) , SF-36 Emotional Role Limitations ( P < 0.01 ) , SRT eyes open ( P < 0.001 ) , SRT eyes closed ( P < 0.001 ) , and TSS ( P < 0.001 ) were determined to be superior in group 1 at the end of the sixth month . Seventy-four percent of patients in group 1 engaged in regular physical activities , and 92 % of them declared that they understood the purpose and benefits of medications and  dietary calcium intake . Fifty-seven percent of them formed personal plans for preventing traumas , whereas 8 % of the subjects in group 2 experienced new falls but no fractures . Conclusion : It is determined that the self-management class led to improvements in functional , balance , and life- quality outcomes and to reductions in pain perception Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field 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 Introduction Adherence to treatment in osteoporosis remains poor . The aim of this study was to evaluate the effects of an educational leaflet on adherence to medication and to assess the association between adherence and health-related quality of life ( HRQOL ) . Methods A naturalistic , observational , multi-center , prospect i ve study of 12 months ’ follow-up was performed . Consecutive post-menopausal women aged 50 years to 86 years starting treatment with raloxifene according to daily practice were enrolled from 126 primary care offices in Spain . The women were assigned to two study groups . Group A received an educational leaflet with general information about osteoporosis ; group B followed current practice . To assess adherence to medication and HRQOL , the Morisky test and the EuroQoL question naire were administered . A total of 745 post-menopausal women ( group A , n=366 ; group B n=379 ) , with a mean age of 62 years , were included . Results Most patients in both study groups showed high adherence to raloxifene at the 3-month visit : 56.3 % vs 62.7 % for groups A and B , respectively ; this proportion at the 12-month visit was 47.4 % ( P=0.15 ) and 52.5 % ( P=0.02 ) , respectively . At baseline , “ pain/discomfort ” was the dimension showing the highest percentage of women reporting problems : 86.4 % vs 83.2 % in groups A and B , respectively ( P=0.22 ) . HRQOL improved in both groups throughout the study , with an overall mean increment in the EuroQoL visual analog scale ( EQ VAS ) of 9.2 at 12 months ( P<0.01 ) . Correlations between adherence and HRQOL were weak . After receiving an educational leaflet , young post-menopausal women suffering osteoporosis did not show improvement in adherence to therapy . HRQOL improved at 12-month follow-up under treatment . Conclusion No consistent correlation between adherence and HRQOL was found Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy . In this study , we aim ed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis . In the present national , multicenter , r and omized controlled study , postmenopausal osteoporosis patients ( 45 - 75 years ) who were on weekly bisphosphonate treatment were r and omized to active training ( AT ) and passive training ( PT ) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment . Both groups received a bisphosphonate usage guide and osteoporosis training booklets . Additionally , AT group received four phone calls ( at 2nd , 5th , 8th , and 11th months ) and participated to four interactive social/training meetings held in groups of 10 patients ( at 3rd , 6th , 9th , and 12th months ) . The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis ( QUALEFFO-41 ) question naire .. Of 448 patients ( mean age 62.4±7.7 years ) , 226 were r and omized to AT group and 222 were r and omized to PT group . Among the study visits , the most common reason for not receiving treatment regularly was forgetfulness ( 54.9 % for visit 2 , 44.3 % for visit 3 , 51.6 % for visit 4 , and 43.8 % for visit 5 ) , the majority of the patients always used their drugs regularly on recommended days and dosages ( 63.8 % for visit 2 , 60.9 % for visit 3 , 72.1 % for visit 4 , and 70.8 % for visit 5 ) , and most of the patients were highly satisfied with the treatment ( 63.4 % for visit 2 , 68.9 % for visit 3 , 72.4 % for visit 4 , and 65.2 % for visit 5 ) and wanted to continue to the treatment ( 96.5 % for visit 2 , 96.5 % for visit 3 , 96.9 % for visit 4 , and 94.4 % for visit 5 ) . QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 ( 37.7±25.4 vs. 34.0±14.6 , p<0.001 ) ; however , the difference was not significant between AT and PT groups both in visit 1 and visit 5 . In conclusion , in addition to active training , passive training provided at the 1st visit did not improve the persistence and compliance of the patients for bisphosphonate treatment 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 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 Summary Guidelines suggest identification of women at fracture risk by bone density measurement and subsequently pharmacotherapy . However , most women who sustain a hip fracture do not have osteoporosis in terms of bone density . The present non-pharmacological intervention among elderly women unselected for osteoporosis reduced hip fracture risk by 55 % providing an alternative approach to fracture prevention . Introduction Hip fractures are expensive for society and cause disability for those who sustain them . We studied whether a multifactorial non-pharmacological prevention program reduces hip fracture risk in elderly women . Methods A controlled trial concerning 60- to 70-year-old community-dwelling Finnish women was undertaken . A r and om sample was drawn from the Population Information System and assigned into the intervention group ( IG ) and control group ( CG ) . Of the 2,547 women who were invited to the IG , 1,004 ( 39 % ) and of the 2,120 invited to the CG , 1,174 ( 55 % ) participated . The IG participated in a fracture prevention program for 1 week at a rehabilitation center followed by review days twice . The CG received no intervention . During the 10-year follow-up , both groups participated in survey question naire by mail . Outcome of interest was occurrence of hip fractures and changes in bone – health-related lifestyle . Results During the follow-up , 12 ( 1.2 % ) women in the IG and 29 ( 2.5 % ) in the CG sustained a hip fracture ( P = 0.039 ) . The determinants of hip fractures by stepwise logistic regression were baseline smoking ( odds ratio ( OR ) 4.32 ( 95 % confidence interval [ CI ] 2.14–8.71 ) , age OR 1.15/year ( 95 % CI 1.03–1.28 ) , fall history OR 2.7 ( 95 % CI 1.24–5.9 ) , stroke history OR 2.99 ( 95 % CI 1.19–7.54 ) and participating in this program OR 0.45 ( 95 % CI 0.22–0.93 ) . Starting vitamin D and calcium supplement use was more common in the IG compared with the CG . Conclusions The results suggest that this non-pharmacological fracture prevention program may reduce the risk of hip fractures in elderly Finnish women 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 An 8-week , bone-health community program addressed risks/lifestyle changes within the Health Belief Model and Theory of Reasoned Action frameworks in a r and omized format ( treatment group n = 35 ; control group n = 34 ) . Median week 1 values for calcium ( control , 963 mg ; treatment , 1023 mg ) and vitamin D ( 81 IU both groups ) were below recommendations , increasing throughout the program for both control ( 1023 mg calcium , 128 IU vitamin D ) and treatment ( 1005 mg calcium , 122 IU vitamin D ) groups . There was limited response to the exercise outcome variables , with many not participating in that section of the program . Psychosocial variables were positive for both control and treatment groups at week 1 , with no significant difference at postintervention . Regression analysis indicated that those with a positive attitude about calcium intake and belief that they could choose calcium-fortified foods were more likely to have higher calcium intake . Intention to exercise was modified by peer and family support . Community-based programs can translate and use clinical trial key topics and outcomes , but participation bias makes impact results difficult to interpret the effectiveness of the program BACKGROUND Treatment of osteoporosis following a hip fracture has been notoriously poor . Many efforts have been made to improve treatment rates . The purpose of this study was to determine whether a perioperative inpatient intervention program , involving patient education and providing a list of questions for the primary care physician , increased the percentage of patients in whom osteoporosis was addressed following a hip fracture . METHODS A prospect i ve , r and omized trial involving eighty patients who had been admitted to an academic medical center with a low-energy hip fracture was conducted . During their hospitalization , the study group patients were engaged in a fifteen-minute discussion regarding the association between osteoporosis and hip fractures , the efficacy of dual-energy x-ray absorptiometry scans in the diagnosis of osteoporosis and of bisphosphonates in its treatment , and the importance of medical follow-up for osteoporosis management . These patients were also provided with five questions regarding osteoporosis treatment to be given to their primary medical physician , and they were reminded about the questions during a follow-up telephone call six weeks later . The patients in the control group received a brochure describing methods for preventing falls . Both groups were contacted by telephone at six months after discharge to determine whether osteoporosis had been addressed . Positive indicators of intervention included assessment of bone mineral density with dual-energy x-ray absorptiometry and initiation of antiresorptive therapy .  RESULTS The average age in each group was eighty-two years , and 78 % of the patients were female . Four patients in each group did not survive through the six-month follow-up period and were excluded from the trial . Fifteen ( 42 % ) of the thirty-six patients who had been r and omized to the study group , compared with only seven ( 19 % ) of the thirty-six patients in the control group , had their osteoporosis addressed by their primary physician . This difference between the groups was significant ( p = 0.036 ) . CONCLUSIONS Patients who were provided with information and questions for their primary care physician about osteoporosis were more likely to receive appropriate therapeutic intervention than were patients who had not received the information and questions . Orthopaedic surgeons have a unique opportunity to improve the rate of osteoporosis treatment in the perioperative period following a hip fracture by educating patients and directing them toward channels for long-term osteoporosis management Summary This study evaluated the effect of a multifaceted intervention ( screening and patient education ) by community pharmacists on testing or treatment of osteoporosis . One hundred and twenty-nine patients r and omized to receive the intervention were compared to 133 patients who did not receive the intervention . Twice as many patients who got the intervention received further testing or treatment for osteoporosis . Introduction The objective of this study was to determine the effect of a community pharmacist screening program on testing and treatment of osteoporosis . Methods In this r and omized , controlled trial , 262 patients meeting bone mineral density ( BMD ) testing guidelines [ men or women aged ≥ 65 years or 50–64 years with one major risk factor including previous fracture , family history of osteoporosis , glucocorticoids for > 3 months , or early menopause ] were allocated to intervention ( 129 ) or control ( 133 ) . Intervention consisted of printed material s , education , and quantitative ultrasound . Primary outcome was a composite endpoint of BMD or prescription for osteoporosis medication within 4 months . Results Primary endpoint of BMD or osteoporosis treatment was achieved by 28 intervention patients ( 22 % ) compared with 14 controls ( 11 % ) ( RR 2.1 , 95 % CI 1.1–3.7 ) . This was driven by BMD testing ( 28 ( 22 % ) vs. 13 ( 10 % ) for controls , p = 0.011 ) . Calcium intake increased more among intervention patients than controls ( 30 % vs. 19 % , RR 1.6 , 95 % CI 1.0–2.5 ) . There was no effect on knowledge or quality of life . Conclusion A pharmacist screening program doubled the number of patients tested for osteoporosis . Nevertheless , many patients eligible for BMD did not receive appropriate care suggesting more intensive interventions are needed UNLABELLED The impact of clinical risk factor-based absolute risk methods on the prevalence of  high risk for osteoporotic fracture  is unknown . We applied absolute risk methods to 6646 subjects and found that the prevalence of  elderly women deemed to be at high risk increased substantially , whereas the overall prevalence was highly dependent on the threshold used to design ate high risk . INTRODUCTION Many groups have advocated using absolute risk methods that incorporate clinical risk factors to target patients for osteoporosis therapy . We examined how the application of such absolute risk classification systems influences the prevalence of those considered to be at high risk for osteoporotic fracture and compared these systems to one based solely on BMD . MATERIAL S AND METHODS Using 6646 subjects from the Canadian Multicentre Osteoporosis Study ( CaMos ) , a prospect i ve , r and omly selected , population -based cohort , we assessed three different systems for determining prevalence of high risk for osteoporotic fracture : a BMD-based system ; a simplified risk factor system incorporating age , sex , BMD , and two clinical risk factors ; and a comprehensive system , incorporating age , sex , BMD , and seven clinical risk factors . The 10-year absolute risks of incident fragility fracture were compared across systems using three different high-risk thresholds . RESULTS The prevalence of a T score < or = -2.5 was 18.8 % ( 95 % CI : 17.7 - 19.9 % ) in women and 3.9 % ( 95 % CI : 3.0 - 4.7 % ) in men . Using a 15 % 10-year risk of fracture threshold , the prevalence of women at high risk increased to 46.9 % ( 95 % CI : 45.4 - 48.4 ) and 42.5 % ( 95 % CI : 41.1 - 43.9 ) when the comprehensive and simplified risk factor classification systems were used , respectively . Using a 25 % 10-year absolute risk threshold , the prevalence of high risk was similar to that of the BMD-based system , whereas the 20 % threshold gave intermediate rates . All thresholds analyzed result ed in an increased prevalence of  older women  at  high risk for fracture , whereas only the 15 % 10-year risk of fracture threshold result ed in an increase in the prevalence of men at high risk . CONCLUSIONS The application of risk factor-based systems results in an increased prevalence of older women at high risk  . The prevalence of individuals at high risk may increase with changes to the methods used to determine those who are eligible for therapy . These data have important implication s for the pattern of care and costs of treating osteoporotic fractures Background and aims : Given the high risk of subsequent fracture among elderly persons with fracture , it is important to initiate secondary treatment for osteoporosis . Acute rehabilitation centers may offer a unique opportunity to introduce treatment . Therefore , we evaluated willingness-to-participate and compliance with evidence -based interventions for the secondary prevention of  osteoporotic fracture in a non-r and omized study conducted in the acute rehabilitation setting . We also described differences in baseline characteristics between study participants and non- participants . Methods : All consecutive , community-dwelling admissions to an acute rehabilitation unit ( Boston , MA ) with the diagnosis of fracture were screened for enrollment . Eligible subjects were offered a free , 6-month supply of alendronate/cholecalciferol ( 70 mg/2800 IU weekly ) , calcium and vitamin D supplements , and fall prevention strategies . Six-month compliance ( ≥75 % consumption of medication or supplement ) with the interventions was determined at a home visit . Results : Among 62 eligible subjects , 25 agreed to participate . Non- participants were older than participants ( 86 vs 80 yrs , p<0.01 ) . There was no significant difference between other characteristics of participants and non- participants including sex , weight , type of fracture , cognitive status , and functional status . The most common reason for non-participation was reluctance to take another medication . Among participants , only 52 % were compliant with alendronate and 58 % were compliant with calcium and vitamin D supplementation at 6 months . Conclusions : Willingness-to-participate and compliance with secondary prevention strategies for osteoporosis was low in the acute rehabilitation setting , even when medications were provided free of cost . Educating individuals with fracture and their families on the consequences and treatment of osteoporosis may help to decrease the risk of sustaining a second fracture by accepting secondary preventive measures In a r and omized trial , we demonstrated that a community pharmacist osteoporosis screening intervention doubled the rates of bone mineral density ( BMD ) testing in high-risk patients . The purpose of this secondary analysis was to evaluate the potentially modifiable factors associated with BMD testing .  From 2005 to 2007 , 15 pharmacies r and omized 262 patients to intervention ( education , pamphlets , point-of-care quantitative heel ultrasound [ QUS ] ) or usual care . The main outcome was BMD testing within 4mo . Multivariate regression was used to determine independent correlates of BMD testing .  The median age of the cohort was 62yr , 65 % were women , and 49 % ( n=129 ) were r and omized to intervention . Compared with patients who were not tested , those with BMD were more likely to be women ( p=0.007 ) and have excellent or very good health ( p<0.001 ) . Postr and omization correlates of BMD test were intervention ( p=0.017 ) , greater osteoporosis knowledge ( p=0.004 ) , and osteoporosis-specific physician visits ( p<0.001 ) . In adjusted analyses , only female sex ( adjusted odds ratio [ aOR ] : 3.0 ; 95 % confidence interval [ CI ] : 1.3 - 7.4 ) and osteoporosis-specific visits ( aOR : 3.2 ; 95 % CI : 1.4 - 7.8 ) were independently associated with BMD testing . In analyses restricted to intervention patients , abnormal QUS ( aOR : 3.7 , 95 % CI : 1.4 - 9.1 ) was the only independent predictor of BMD test . Future interventions should incorporate the finding that osteoporosis-specific visits and abnormal QUS results were strongly associated with getting a BMD testing and should give greater attention to men
target: 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 .
background: 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 .