Improving Care of Patients At-Risk for Osteoporosis: A Randomized Controlled Trial

Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials

“…Authors were contacted to verify the accuracy of reporting of these criteria in their studies -we received verification from the authors of six studies (46%) 31,34,35,[40][41][42] . We decided not to use a quality assessment scale because evidence exists that they lack empirically supported components 27 , and authors of scales can be influenced by their own perception of study quality 28 .…”

“…Of these, 1,246 citations were screened for relevance, 42 articles were selected for full-text review, and 13 RCTs met the inclusion/exclusion criteria and were included in the systematic review [30][31][32][33][34][35][36][37][38][39][40][41][42] …”

“…Reported study quality was generally poor-only four studies indicated all of sequence generation, concealment of randomization, blinding (Table 1) 31, [33][34][35] , the inclusion of at least 80% of patients in the analysis, and a description of reasons for dropouts/withdrawals (Table 2) 31, [33][34][35] . The follow-up period ranged between 2 and 28 months, and only four studies were analyzed according to ITT (Table 2) 31, 33,40,42 . Table 3 shows the clinical heterogeneity across studies according to population and interventions, which also contributed to our decision not to combine results in a meta-analysis.…”

“…Table 3 shows the clinical heterogeneity across studies according to population and interventions, which also contributed to our decision not to combine results in a meta-analysis. Populations varied across studies for osteoporosis risk factors: age ≥65 years of age (six studies) 30, 33, 35, 36, 41, 42, postmenopausal women (3 studies) 34, 38, 39, previous fracture (six studies), and at least 6 months use of glucocorticoids (five studies) [40][41][42] . Differences were also found between studies for 42 ‡ Practice Done Not done Not done *Unclear = Authors did not report or provide a description for sequence generation or allocation concealment of randomization that allowed classification of "done" or "not done" †Unclear = Authors did not report or provide an indication of who, if anyone, was unaware of group assignment that allowed classification of "done" or "not done" ‡Data verified by author 42 ‡ 10 months 100% Done None Yes *Unclear = Authors did not report or provide a description for sequence generation or allocation concealment of randomization that allowed classification of "done" or "not done" †Unclear = Authors did not report or provide an indication of who, if anyone, was unaware of group assignment that allowed classification of "done" or "not done" ‡Data verified by author Of these, three studies included a reminder with or without a risk assessment strategy (Table 4) 30 -32 , and 8 studies included a reminder system plus education with or without a risk Intervention: A CME program conducted during the Phys visit by a Pharm educator, who received 1-day training on OP.…”

“…Pts received a letter and then an automated telephone call (tailored Ed) inviting them to have a BMD test, which they could schedule immediately after the call. Women age ≥65 years, women or men age ≥45 years with a prior fracture, or women or men taking glcuocorticoids for ≥90 days *GP = general practitioner; OP = osteoporosis; RA = risk assessment; Phys = physicians; Pts = patients; PCP = primary care physician; UC = usual care; BMD = bone mineral density; Ed = education; EMR = electronic medical record; SCORE = simple calculated osteoporosis risk estimation; SOF = study of osteoporotic fracture; HRT = hormone replacement therapy; GIOP = glucocorticoid-induced osteoporosis; Pharms = pharmacists; DXA = dual-energy X-ray absorptiometry; CME = continuing medical education assessment strategy (Table 5) 34-38, [40][41][42] . Two studies investigated interventions that included education with exercise or risk assessment (Table 6) 33, 39 .…”