Abstract
Summary
This population-based study of mid-aged Canadians assessed awareness of diagnosis by bone mineral density (BMD) following dual-energy X-ray absorptiometry (DXA) testing and compared the effects of feedback only to the physician with direct-to-participant feedback. Poor recall of osteoporosis results was observed irrespective of the feedback destination, but direct-to-participant feedback improved recall of borderline or normal results.
Introduction
BMD testing provides information about fracture risk. This study assessed whether awareness of results, in a random population sample of mid-aged Canadians, differed if results were provided to physicians only or directly to participants.
Methods
Prospective cohort study of 2,678 women and men aged 40–60 years from the Canadian Multicentre Osteoporosis Study. Participants completed hip and spine DXA and interviewer-administered questionnaires regarding demographics and osteoporosis risk factors. Lateral spine X-rays were conducted on those ≥50 years of age. All test results were reported to the participant, the family physician or both. Associations between BMD results, feedback destination and correct self-report results, 3 years later, were assessed using logistic regression while adjusting for potential confounders.
Results
Only 25% of men and 33% of women correctly reported their osteoporosis diagnoses. Direct-to-participant vs. physician-only reports did not improve recall of osteoporosis diagnosis but improved recall of borderline or normal BMD. Older (vs. younger) men and men with prevalent vertebral fractures demonstrated better recall of their osteoporosis diagnosis.
Conclusions
Recall of low BMD results was poor, despite direct-to-participant feedback and even in the presence of other osteoporosis risk factors. Direct-to-participant feedback may improve awareness of borderline or normal BMD results.
References
Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(10 Suppl):S1–S34
Siminoski K, Leslie WD, Frame H et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56(3):178–188
World Health Organization (2007) World Health Organisation Scientific Group on the Assessment of Osteoporosis at the Primary Health Care Level Summary Meeting Report, Brussels, Belgium 5–7 May 2004
Rubin SM, Cummings SR (1992) Results of bone densitometry affect women’s decisions about taking measures to prevent fractures. Ann Intern Med 116(12 Pt 1):990–995
Jamal SA, Ridout R, Chase C, Fielding L, Rubin LA, Hawker GA (1999) Bone mineral density testing and osteoporosis education improve lifestyle behaviors in premenopausal women: a prospective study. J Bone Miner Res 14(12):2143–2149
Winzenberg T, Oldenburg B, Frendin S, De Wit L, Riley M, Jones G (2006) The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260]. BMC Public Health 6:12
McLeod KM, McCann SE, Horvath PJ, Wactawski-Wende J (2007) Predictors of change in calcium intake in postmenopausal women after osteoporosis screening. J Nutr 137(8):1968–1973
Patel A, Coates PS, Nelson JB, Trump DL, Resnick NM, Greenspan SL (2003) Does bone mineral density and knowledge influence health-related behaviors of elderly men at risk for osteoporosis? J Clin Densitom 6(4):323–330
Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL (2003) Primary care: is there enough time for prevention? Am J Public Health 93(4):635–641
Pimlott N (2008) Who has time for family medicine? Can Fam Physician 54(1):14–16
Ong LM, de Haes JC, Hoos AM, Lammes FB (1995) Doctor–patient communication: a review of the literature. Soc Sci Med 40(7):903–918
Campbell MK, Torgerson DJ, Thomas RE, McClure JD, Reid DM (1998) Direct disclosure of bone density results to patients: effect on knowledge of osteoporosis risk and anxiety level. Osteoporos Int 8(6):584–590
Kreiger N, Tenenhouse A, Joseph L et al (1999) Research notes: the Canadian Multicentre Osteoporosis Study (CaMos): background, rationale, methods. Can J Aging 18(3):376–387
Tenenhouse A, Kreiger N, Hanley D (2000) Canadian Multicentre Osteoporosis Study (CaMos). Drug Dev Res 49:201–205
Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141
Fitt NS, Mitchell SL, Cranney A, Gulenchyn K, Huang M, Tugwell P (2001) Influence of bone densitometry results on the treatment of osteoporosis. CMAJ 164(6):777–781
Pickney CS, Arnason JA (2005) Correlation between patient recall of bone densitometry results and subsequent treatment adherence. Osteoporos Int 16(9):1156–1160
Tosteson AN, Grove MR, Hammond CS et al (2003) Early discontinuation of treatment for osteoporosis. Am J Med 115(3):209–216
Cadarette SM, Beaton DE, Gignac MA, Jaglal SB, Dickson L, Hawker GA (2007) Minimal error in self-report of having had DXA, but self-report of its results was poor. J Clin Epidemiol 60(12):1306–1311
Weinstein ND (1982) Unrealistic optimism about susceptibility to health problems. J Behav Med 5(4):441–460
Weinstein ND (1989) Optimistic biases about personal risks. Science 246(4935):1232–1233
Rimes KA, Salkovskis PM, Shipman AJ (1999) Psychological and behavioural effects of bone density screening for osteoporosis. Psychol Health 14:585–608
Timko C, Janoff-Bulman R (1985) Attributions, vulnerability, and psychological adjustment: the case of breast cancer. Health Psychol 4(6):521–544
Taylor SE, Kemeny ME, Aspinwall LG, Schneider SG, Rodriguez R, Herbert M (1992) Optimism, coping, psychological distress, and high-risk sexual behavior among men at risk for acquired immunodeficiency syndrome (AIDS). J Pers Soc Psychol 63(3):460–473
Sedlak CA, Doheny MO, Estok PJ (2000) Osteoporosis in older men: knowledge and health beliefs. Orthop Nurs 19(3):38–42
Jaglal SB, Weller I, Mamdani M et al (2005) Population trends in BMD testing, treatment, and hip and wrist fracture rates: are the hip fracture projections wrong? J Bone Miner Res 20(6):898–905
Naessen T, Parker R, Persson I, Zack M, Adami HO (1989) Time trends in incidence rates of first hip fracture in the Uppsala Health Care Region, Sweden, 1965–1983. Am J Epidemiol 130(2):289–299
Melton LJ III, Atkinson EJ, Madhok R (1996) Downturn in hip fracture incidence. Public Health Rep 111(2):146–151
Lofman O, Berglund K, Larsson L, Toss G (2002) Changes in hip fracture epidemiology: redistribution between ages, genders and fracture types. Osteoporos Int 13(1):18–25
Kanis JA, Johansson H, Oden A et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 19(6):893–899
Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382
Kanis JA, Johnell O, Oden A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16(2):155–162
FRAX WHO Fracture Risk Assessment Tool (2008) www.shef.ac.uk/FRAX/reference.htm. Accessed 28 July 2008
Stock JL, Waud CE, Coderre JA et al (1998) 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 128(12 Pt 1):996–999
Wallace LM, Wright S, Parsons A, Wright C, Barlow J (2002) The impact of screening for osteoporosis on bone protecting exercise and dietary calcium intake. Psychol Health Med 7(4):477–488
O’Neill TW, Marsden D, Matthis C, Raspe H, Silman AJ (1995) Survey response rates: national and regional differences in a European multicentre study of vertebral osteoporosis. J Epidemiol Community Health 49(1):87–93
Jones G, White C, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1996) Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 6(3):233–239
Statistics Canada (2004) Statistics Canada 1996 census tables. www.statcan.gc.ca/c1996-r1996/nation-pays2-eng.htm. Accessed 18 December 2008
Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8(5):468–489
Tenenhouse A, Joseph L, Kreiger N et al (2000) Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 11(10):897–904
Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. Bone 27(5):585–590
Ahmed AI, Blake GM, Rymer JM, Fogelman I (1997) Screening for osteopenia and osteoporosis: do the accepted normal ranges lead to overdiagnosis? Osteoporos Int 7(5):432–438
Hanson J, Felsenberg D, Fuerst T et al (1997) Letter. Bone 21(4):369–370
Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11
Hamel ME, Sebaldt RJ, Siminoski K et al (2005) Influence of fracture history and bone mineral density testing on the treatment of osteoporosis in two non-academic community centers. Osteoporos Int 16(2):208–215
Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35(5):293–305
Jaglal SB, Carroll J, Hawker G et al (2003) How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 49:462–468
Acknowledgements
Dr. Kingwell was supported by a Canadian Institutes for Health Research (CIHR) and Health Canada Joint Doctoral Research Award and a Michael Smith Foundation for Health Research (MSFHR) Doctoral Trainee Award. Dr. Ratner is supported through an MSFHR Senior Scholar Award. We thank the CaMOS steering committee for sharing their data and facilities and the CaMOS participants for willingly donating their time and personal information. We also thank the anonymous reviewers for their helpful comments and suggestions.
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Kingwell, E., Prior, J.C., Ratner, P.A. et al. Direct-to-participant feedback and awareness of bone mineral density testing results in a population-based sample of mid-aged Canadians. Osteoporos Int 21, 307–319 (2010). https://doi.org/10.1007/s00198-009-0966-2
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DOI: https://doi.org/10.1007/s00198-009-0966-2