Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Studies indicate a gap between evidence and clinical practice in osteoporosis management. Tools that facilitate clinical decision making at the point of care are promising strategies for closing these practice gaps.
To systematically review the literature to identify and describe the effectiveness of tools that support clinical decision making in osteoporosis disease management.
Medline, EMBASE, CINAHL, and EBM Reviews (CDSR, DARE, CCTR, and ACP J Club), and contact with experts in the field.
Randomized controlled trials (RCTs) in any language from 1966 to July 2006 investigating disease management interventions in patients at risk for osteoporosis. Outcomes included fractures and bone mineral density (BMD) testing. Two investigators independently assessed articles for relevance and study quality, and extracted data using standardized forms.
Of 1,246 citations that were screened for relevance, 13 RCTs met the inclusion criteria. Reported study quality was generally poor. Meta-analysis was not done because of methodological and clinical heterogeneity; 77% of studies included a reminder or education as a component of their intervention. Three studies of reminders plus education targeted to physicians and patients showed increased BMD testing (RR range 1.43 to 8.67) and osteoporosis medication use (RR range 1.60 to 8.67). A physician reminder plus a patient risk assessment strategy found reduced fractures [RR 0.58, 95% confidence interval (CI) 0.37 to 0.90] and increased osteoporosis therapy (RR 2.44, CI 1.43 to 4.17).
Multi-component tools that are targeted to physicians and patients may be effective for supporting clinical decision making in osteoporosis disease management.
- Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporosis Int. 1997;7:407–13. CrossRef
- Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obst Gynecol. 2006;194:S3–11. CrossRef
- National Osteoporosis Society. Available at: http://www.nos.org.uk/: Accessed September, 2008.
- Osteoporosis Canada. Available at: http://www.osteoporosis.ca/english/home/: Accessed September, 2008.
- Hajcsar EE, Hawker G, Bogoch ER. Investigation and treatment of ostoporosis in patients with fragility fractures. CMAJ. 2000;163:819–22.
- Johnell O, Kanis JA, Oden A, et al. Mortality after osteoporotic fractures. Osteoporosis Int. 2004;15:38–42. CrossRef
- Reginster J, Burlet N. Osteoporosis: A still increasing prevalence. Bone. 2006;38:S4–9. CrossRef
- Lips P, van Schoor NM. Quality of life in patients with osteoporosis. Osteoporosis Int. 2005;16:447–55. CrossRef
- Goeree ROB, Pettitt DB, Cuddy L, et al. An assessment of the burden of illness due to osteoporosis in Canada. J Soc Obstet Gynaecol Can. 1996;18(Suppl):15–24.
- Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. The Lancet. 2002;359:1761–7. CrossRef
- Poole KES, Compston JE. Clinical review: Osteoporosis and its management. BMJ. 2006;333:1251–6. CrossRef
- International Osteoporosis Foundation. Available at: http://www.iofbonehealth.org/facts-and-statistics.html: Accessed September 2008.
- Brown JP, Josse RG, for the Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada (revised, August 26, 2004). CMAJ. 2002;167(10):S1–34.
- Osteoporosis, Clinical Guidelines for Prevention and Treatment: Update on pharmacological interventions and algorithm for management. Royal College of Physicians, Bone and Tooth Society of Great Britain, 2003. Available at: http://www.rcplondon.ac.uk: Accessed September 2008.
- ACOG Committee on Practice Bulletins. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 50, January 2004. Osteoporosis Obstet Gynecol. 2004;103(1):203–16.
- Jaglal SB, McIsaac WJ, Hawker G, et al. Information needs in the management of osteoporosis in family practice: an illustration of the failure of the current guideline implementation process. Osteoporosis Int. 2003;14:672–6. CrossRef
- Jaglal SB, Carroll J, Hawker G, et al. How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Phys. 2003;49:462–8.
- Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD. The osteoporosis care gap in Canada. BMC Musculoskelet Disord. 2004;6:5–11.
- Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assessment. 2004;(86):iii–iv, 1–72.
- Smith SA, Murphy ME, Huschka TR, et al. Impact of a diabetes electronic management system on the care of patients seen in a subspecialty diabetes clinic. Diabetes Care. 1998;21:972–6. CrossRef
- Baker AM, Lafatat JE, Ward RE, Whitehouse F, Divine G. A web-based diabetes care management support system. J Qual Improv. 2001;27(4):179–90.
- Finkelstein J, O’connor G, Friedmann RH. Development and implementation of the home asthma telemonitoring (HAT) system to facilitate asthma self-care. Medinfo. 2001;10(Pt 1):810–4.
- Roccaforte R, Demers C, Baldassarre F, Teo KK, Yusuf S. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. Eur J Heart Fail. 2005;7(7):1133–44. CrossRef
- Gonseth J, Guallar-Castillon P, Banegas JR, Rodriguez-Artalejo F. The effectiveness of disease management programmes in reducing hospital re-admission in older patients with heart failure: a systematic review and meta-analysis of published reports. Eur Heart J. 2004;25:1570–95. CrossRef
- Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ. 2000;162(9):1289–94.
- Haynes RB, McKibbon KA, Wilczynski NL, Walter SD, Werre SR, Hedges Team. Optimal search strategies for retrieving scientifically strong studies of treatment from Medline: analytical survey. BMJ. 2005;330(7501):1179. CrossRef
- Jüni P, Witschi A, Bloch R, Egger M. The hazards of scoring the quality of clinical trials for meta-analysis. JAMA. 1999;282(11):1054–60. CrossRef
- Moyer A, Finney JW. Rating methodologic quality: toward improved assessment and investigation. Account Res. 2005;12(4):299–313.
- Egger M, Smith GD, Altman DG. Systematic reviews in health care: Meta-analysis in context. London: BMJ Publishing Group; 2001:309–10;395–6.
- Barr RJ, Stewart A, Torgerson DJ, Seymour DG, Reid DM. Screening elderly women for risk of future fractures—Participation rates and impact on incidence of falls and fractures. Calcif Tissue Int. 2005;76:243–8. CrossRef
- Bliuc D, Eisman JA, Center JR. A randomized study of two different information-based interventions on the management of osteoporosis in minimal and moderate trauma fractures. Osteoporos Int. 2006;17(9):1309–17. CrossRef
- Boyd JL, Holcomb JP, Rothenberg RJ. Physician treatment of osteoporosis in response to heel ultrasound bone mineral density reports. J Clin Densitometry. 2002;5(4):375–81. CrossRef
- Devereux K, Robertson D, Briffa NK. Effects of a water-based program on women 65 years and over: a randomized controlled trial. Aust J of Physiother. 2005;51:102–8.
- Feldstein A, Elmer PJ, Smith DH, et al. Electronic medical record reminder improves osteoporosis management after a fracture: a randomized, controlled trail. J Am Geriatr Soc. 2006;54(3):450–7. CrossRef
- Gardner MJ, Brophy RH, Demetrakopoulos D, et al. Interventions to improve osteoporosis treatment following hip fracture. J Bone and Joint Surg. 2005;87:3–7. CrossRef
- LaCroix AZ, Buist DSM, Brenneman SK, Abbott TA. Evaluation of three population-based strategies for fracture prevention. Medical Care. 2005;43:293–302. CrossRef
- McDonough RP, Doucette WR, Kumbera P, Klepser DG. An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis. Value in Health. 2005;8(1):24–31. CrossRef
- Morrison LS, Tobias JH. Effect of a case-finding strategy for osteoporosis on bisphosphonate prescribing in primary care. Osteoporosis Int. 2005;16(1):71–7. CrossRef
- Rolnick SJ, Kopher R. What is the impact of osteoporosis education and bone mineral density testing for postmenopausal women in a managed care setting? Menopause. 2001;8(2):141–8. CrossRef
- Solomon DH, Katz JN, La Tourette AM, Coblyn JS. Multifaceted intervention to improve reumatologists’ management of glucocorticoid-induced osteoporosis: A randomized controlled trial. Arthritis & Rheumatism. 2004;51:383–7. CrossRef
- Solomon DH, Finkelsteing JS, Polinski JM, et al. A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporosis Int. 2006;17:760–7. CrossRef
- Solomon DH, Polinski JM, Stedman M, et al. Improving care of patients at-risk for osteoporosis: A randomized controlled trial. J Gen Intern Med. 2007;22(3):362–7. CrossRef
- Allen ML, Wyatt LE. Guidelines for the diagnosis, screening, and treatment of osteoporosis in women. Adv Studies Med. 2005;5(10):518–23.
- Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC. Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev. 2005;25(1):CD004017, Jan.
- Bai B, Wang KZ, Liu WK, Song JH, Chen JC. Comprehensive treatment for old patients with hip fractures. Chin J Traumatol. 2003;6(5):297–301.
- Berard A, Bravo G, Gauthier P. Meta-analysis of the effectiveness of physical activity for the prevention of bone loss in postmenopausal women. Osteoporosis Int. 1997;7(4):331–7. CrossRef
- Berarducci A. The effects of an osteoporosis preventive cognitive/behavioural intervention on knowledge, self-efficacy, role strain, and intention in midlife women. University of South Florida PhD dissertation.
- Blalock SJ, Currey SS, DeVellis RF, et al. Effects of educational materials concerning osteoporosis on women’s knowledge, beliefs, and behaviour. Am J Health Prom. 2000;14(3):161–9.
- Bonaiuti D, Cranney A, Iovine R, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2002;(3):CD000333.
- Boulos P, Adachi JD. Guidelines for the prevention and therapy of glucocorticoid-induced osteoporosis. Clin Exp Rheumatol. 2000;18(Suppl 21):S79–86.
- Brenneman SK, Lacroix AZ, Buist DSM, Chen Y, Abbott TA III. Evaluation of decision rules to identify postmenopausal women for inervention related to osteoporosis. Dis Manage. 2003;6:159–68. CrossRef
- Buist DSM, LaCroix AZ, Manfredonia D, Abbott T. Identifying postmenopausal women at high risk of fracture in populations: a comparison of three strategies. J Am Geriatrics Soc. 2002;50(6):1031–8. CrossRef
- Colon-Emeric CS, Caminis J, Suh TT, et al. The HORIZON Recruitment Fracture Trial: Design of a clinical trial in the prevention of subsequent fractures after low trauma hip fracture repair. Curr Med Res Opin. 2004;20(6):903–10. CrossRef
- Delafuente JC, Weakley DF. Can an educational program for residents of assisted living facilities improve drug utilization for osteoporosis? Consultant Pharmacist. 2005;20(2):137–40.
- Devogelaer J-P, Goemaere S, Boonen S, et al. Evidence-based guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis: A consensus document of the Belgian Bone Club. Osteoporosis Int. 2006;17(1):8–19. CrossRef
- Dhillon V, Creiger J, Hannan J, Hurst N, Nuki G. The effect of DXA scanning on clinical decision making by general practitioners: A randomized, prospective trial of direct access versus referral to a hospital consultant. Osteoporosis Int. 2003;14:326–33. CrossRef
- Edwards BJ, Brooks ER, Langman CB. Osteoporosis screening of postmenopausal women in the primary care setting: A case-based approach. Gender Med. 2004;1(2):70–85. CrossRef
- Gold DT, Shipp KM, Pieper CF, Duncan PW, Martinez S, Lyles KW. Group treatment improves trunk strength and psychological status in older women with vertebral fractures: results osf a randomized, clinical trial. J Am Geriatr Soc. 2004;52:1471–8. CrossRef
- Hunskaar S, Hannestad YS, Backe B, Matheson I. Direct, mailing of consensus recommendations did not alter GPs’ knowledge and prescription of oestrogen in the menopause. Scand J Prim Health Care. 1996;14(4):203–8. CrossRef
- Josse R, Tenengouse AM, Hanley DA, et al. Clinical practice guidelines for the diagnosis and management of osteoporosis. CMAJ. 1996;155(8):1113–29.
- Lock CA, Lecouturier J, Mason JM, Dickinson HO. Lifestyle interventions to prevent osteoporotic fractures: A systematic review. Osteoporosis Int. 2006;17(1):20–8. CrossRef
- McGinley AM. Effect of Web-based computer-tailoring on women’s intention to continue or begin to use hormone replacement therapy to lower their risk for osteoporosis. University of Pennsylvania PhD Dissertation 2002.
- Nelson ME, Fiatarone MA, Morganit CM, Trice I, Greenberg RA, Evans WJ. Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures: a randomized controlled trial. JAMA. 1994;272:1909–14. CrossRef
- O’Connor AM, Stacey D, Entwistle V, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2003;(2):CD001431.
- Polinski JM, Brookhart MA, Katz JN, et al. Educational outreach (academic detailing) regarding osteoporosis in primary care. Pharmacoepidemiol Drug Safety. 2005;14:843–50. CrossRef
- Feder G, Cryer D, Donovan S, Carter Y. Guidelines for the prevention of falls in people over 65. BMJ. 2000;321:1007–11. CrossRef
- Rothert ML, Holmes-Rovner M, Rovner D, et al. An educational intervention as decision support for menopausal women. Res Nurs Health. 1997;20(5):377–87. CrossRef
- Silverman SL, Greenwald M, Klein RA, Drinkwater BL. Effect of bone density information on decisions about hormone replacement therapy: a randomized trail. Obstetrics Gynecol. 1997;89(3):321–5. CrossRef
- Stock JL, Waud CE, Coderre JA, et al. Clinical reporting to primary care physicians leads to increased use and understanding of bone densitometry and affects the management of osteoporosis. A randomized trial. Ann Intern Med. 1998;128(12 Pt 1):996–9.
- Winzenberg T, Oldenburg B, Frendin S, De Wit L, Riley M, Jones G. The effect on behaviour and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial. BMC Pub Health. 2006;6:12. CrossRef
- Cook DJ, Sackett DL, Spitzer WO. Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam consultation on meta-analysis. J Clin Epidemiol. 1995;48:167–71. CrossRef
- Sullivan F, Wyatt JC. How decision support tools help define clinical problems. BMJ. 2005;331:831–3. CrossRef
- Randolph AG, Haynes RB, Wyatt JC, Cook DJ, Guyatt GH. Users’ guides to the medical literature XVII. How to use an article evaluating the clinical impact of a computer-based clinical decision support system. JAMA. 1999;281:67–74. CrossRef
- Garg AX, Adhikari NKJ, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–38. CrossRef
- Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2005;330:765–73. CrossRef
- Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials
Journal of General Internal Medicine
Volume 23, Issue 12 , pp 2095-2105
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- disease management
- decision making
- randomized controlled trials
- Industry Sectors
- Author Affiliations
- 1. Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, Canada, M5T 3M6
- 2. Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada