Osteoporosis International

, Volume 20, Issue 9, pp 1563–1570 | Cite as

Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial

  • K. L. Francis
  • B. L. Matthews
  • W. Van Mechelen
  • K. L. Bennell
  • R. H. OsborneEmail author
Original Article



Osteoporosis is an increasing burden on individuals and health resources. The Osteoporosis Prevention and Self-Management Course (OPSMC) was designed to assist individuals to prevent and manage osteoporosis; however, it had not been evaluated in an Australian setting. This randomised controlled trial showed that the course increased osteoporosis knowledge.

Introduction and hypothesis

Osteoporosis is a major and growing public health concern. An OPSMC was designed to provide individuals with information and skills to prevent or manage osteoporosis, but its effectiveness has not previously been evaluated. This study aimed to determine whether OPSMC attendance improved osteoporosis knowledge, self-efficacy, self-management skills or behaviour.

Materials and methods

Using a wait list randomised controlled trial design, 198 people (92% female) recruited from the community and aged over 40 (mean age = 63) were randomised 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.


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.


The results indicate that the OPSMC is an effective intervention for improving understanding of osteoporosis and some aspects of behaviour in the short term.


Evaluation Knowledge Osteoporosis Patient education Self-management 


Conflicts of interest

No disclosures or conflict of interests to report.


  1. 1.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRefGoogle Scholar
  2. 2.
    Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018PubMedCrossRefGoogle Scholar
  3. 3.
    Gass M, Dawson-Hughes B (2006) Preventing osteoporosis-related fractures: an overview. Am J Med 119:3S–11SCrossRefGoogle Scholar
  4. 4.
    Gold D (2005) Quality of life and its measurement in osteoporosis. In: Maricic M, Gluck OS (eds) Bone disease in rheumatology. Lippincott Williams & Wilkins, Philadelphia, PA, pp 67–79Google Scholar
  5. 5.
    Lorig K, Gonzalez V, Laurent D; Stanford Patient Education Research Centre (1999) The chronic disease self-management program leaders manual. Palo Alto, CAGoogle Scholar
  6. 6.
    Conn V, Russell C (2005) Self-management of chronic illnesses among aging adults. J Gerontol Nurs 31:4PubMedGoogle Scholar
  7. 7.
    Wagner EH (2000) The role of patient care teams in chronic disease management. Br Med J 320:569–572CrossRefGoogle Scholar
  8. 8.
    Pearson JA, Burkhart E, Pifalo WB, Palaggo-Toy T, Krohn K (2005) A lifestyle modification intervention for the treatment of osteoporosis. Am J Health Promot 20:28–33PubMedGoogle Scholar
  9. 9.
    Burckhardt P (2004) Nutrition and osteoporosis. In: Sambrook PN, Geusens P, Lindsay R (eds) Osteoporosis in clinical practice. 2nd edn. Springer, USA, pp 187–192Google Scholar
  10. 10.
    Wark J, Nowson C (2003) Calcium supplementation: the bare bones. Aust Prescr 26:126–127Google Scholar
  11. 11.
    Delaney MF (2006) Strategies for the prevention and treatment of osteoporosis during early postmenopause. Am J Obstet Gynecol 194:S12–S23PubMedCrossRefGoogle Scholar
  12. 12.
    Kannus P, Uusi-Rasi K, Palvanen M, Parkkari J (2005) Non-pharmacological means to prevent fractures among older adults. Ann Med 37:303–310PubMedCrossRefGoogle Scholar
  13. 13.
    Sambrook PN, Geusens P (2004) Normal skeletal structure and function. In: Sambrook PN, Geusens P, Lindsay R (eds) Osteoporosis in clinical practice. 2nd edn. Springer, USA, pp 3–7Google Scholar
  14. 14.
    Eisman J, Clapham S, Kehoe L (2004) Osteoporosis prevalence and levels of treatment in primary care: the Australian bone care study. J Bone Miner Res 19:1969–1975PubMedCrossRefGoogle Scholar
  15. 15.
    Laslett LL, McNeil JD, Lynch J (2004) Patient education—the forgotten link in managing osteoporosis. Aust Fam Physician 33:121–124PubMedGoogle Scholar
  16. 16.
    Coates VE, Boore JRP (1995) Self-management of chronic illness: implications for nursing. Int J Nurs Stud 32:628–640PubMedCrossRefGoogle Scholar
  17. 17.
    Conner M, Norman P (2005) Predicting health behaviour: a social cognition approach. In: Conner M, Norman P (eds) Predicting health behaviour: research and practice with social cognition models. 2nd edn. Open University Press, New York, pp 1–28Google Scholar
  18. 18.
    Tanner EK (2004) Chronic illness demands for self-management in older adults. Geriatr Nurs 25:313–317PubMedCrossRefGoogle Scholar
  19. 19.
    Chodosh J, Morton SC, Mojica W, Maglione M, Suttorp MJ, Hilton L, Rhodes S, Shekelle P (2005) Improving patient care. Meta-analysis: chronic disease self-management programs for older adults. Ann Intern Med 143:427–438PubMedGoogle Scholar
  20. 20.
    Warsi A, LaValley MP, Wang PS, Avorn J, Solomon DH (2003) Arthritis self-management education programs a meta-analysis of the effect on pain and disability. Arthritis Rheum 48:2207–2213PubMedCrossRefGoogle Scholar
  21. 21.
    Nolte S, Elsworth GR, Sinclair AJ, Osborne RH (2006) The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey. Patient Educ Couns 65:351–360PubMedCrossRefGoogle Scholar
  22. 22.
    Winzenberg TM, Oldenburg B, Frendin S, De Wit L, Jones G (2005) Effects of bone density feedback and group education on osteoporosis knowledge and osteoporosis self-efficacy in premenopausal women. J Clin Densitom 8:95–103PubMedCrossRefGoogle Scholar
  23. 23.
    Gold DT, Silverman SL (2004) Osteoporosis self-management: choices for better bone health. South Med J 97(6):551–554PubMedCrossRefGoogle Scholar
  24. 24.
    Australian Government Department of Health and Ageing (2006) COAG health services—promoting good health, prevention and early intervention. Fact sheet. Commonwealth Government, Canberra. (accessed May 2006)
  25. 25.
    Australian Government (2006) Budget. Part 2: expense measures. Canberra: Commonwealth Government. (accessed May 2006)
  26. 26.
    Osteoporosis Victoria (2001a) Everybody’s bones, 3rd edn. Arthritis Foundation of Victoria, Melbourne, AustraliaGoogle Scholar
  27. 27.
    Winzenberg TM, Oldenburg B, Frendin S, Jones G (2003) The design of a valid and reliable questionnaire to measure osteoporosis knowledge in women: the Osteoporosis Knowledge Assessment Tool (OKAT). BMC Musculoskelet Disord 4:17PubMedCrossRefGoogle Scholar
  28. 28.
    Osborne R, Whitfield K, Elsworth G (2007) The health education impact questionnaire (HeiQ): An outcomes and evaluation measure for patient education and self-management interventions for people with chronic conditions. Patient Educ Couns 66(2):192–201PubMedCrossRefGoogle Scholar
  29. 29.
    Horan M, Kim K, Gendler P (1993) Development and evaluation of osteoporosis self-efficacy scale. Paper presented at the Paper presented at the Midwest Nursing Researching Society Conference, Cleveland, OHGoogle Scholar
  30. 30.
    Kulp JL, Rane S, Bachmann G (2004) Impact of preventive osteoporosis education on patient behavior: immediate and 3-month follow-up. Menopause 11:116–119PubMedCrossRefGoogle Scholar
  31. 31.
    Brecher LS, Pomerantz SC, Synder BA, Janora DM, Klotzbach-Shimomura KM, Cavaleri TA (2002) Osteoporosis prevention project: a model multidisciplinary educational intervention. J Am Osteopath Assoc 102:327–335PubMedGoogle Scholar
  32. 32.
    Solomon DH, Finkelstein JS, Polinski JM, Arnold M, Licari A, Cabral D, Canning C, Avorn J, Katz JN (2006) A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporos Int 17:760–767PubMedCrossRefGoogle Scholar
  33. 33.
    Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW Jr, Bandura A, Gonzalez VM, Laurent DD, Holman HR (2001) Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care 39:1217–1223PubMedCrossRefGoogle Scholar
  34. 34.
    Osborne R, Wilson T, Lorig K, McColl G (2007) Does self-management lead to sustainable health benefits in people with arthritis? A two-year transition study of 452 Australians. J Rheumatol 34:1112–1117PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • K. L. Francis
    • 1
  • B. L. Matthews
    • 1
  • W. Van Mechelen
    • 2
  • K. L. Bennell
    • 1
  • R. H. Osborne
    • 3
    Email author
  1. 1.Centre for Health, Exercise and Sports MedicineThe University of MelbourneParkvilleAustralia
  2. 2.Department of Public & Occupational Health and EMGO InstituteVU University Medical CenterAmsterdamThe Netherlands
  3. 3.Centre for Rheumatic Diseases, Department of Medicine, Royal Melbourne HospitalThe University of MelbourneParkvilleAustralia

Personalised recommendations