Osteoporosis International

, Volume 22, Issue 11, pp 2743–2768 | Cite as

Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis

  • M.-C. Laliberté
  • S. Perreault
  • G. Jouini
  • B. J. Shea
  • L. Lalonde


This study aims to evaluate the effectiveness of primary care interventions to improve the detection and treatment of osteoporosis. Eight electronic databases and six gray literature sources were searched. Randomized controlled trials, controlled clinical trials, quasi-randomized trials, controlled before–after studies, and interrupted time series written in English or French from 1985 to 2009 were considered. Eligible studies had to include patients at risk (women ≥ 65 years, men ≥ 70 years, and men/women ≥ 50 years with at least one major risk factor for osteoporosis) or at high risk (men/women using oral glucocorticoids or with previous fragility fractures) for osteoporosis and fractures. Outcomes included bone mineral density (BMD) testing, osteoporosis treatment initiation, and fractures. Data were pooled using a random effects model when applicable. Thirteen studies were included. The majority were multifaceted and involved patient educational material, physician notification, and/or physician education. Absolute differences in the incidence of BMD testing ranged from 22% to 51% for high-risk patients only and from 4% to 18% for both at-risk and high-risk patients. Absolute differences in the incidence of osteoporosis treatment initiation ranged from 18% to 29% for high-risk patients only and from 2% to 4% for at-risk and high-risk patients. Pooling the results of six trials showed an increased incidence of osteoporosis treatment initiation (risk difference (RD) = 20%; 95% CI: 7–33%) and of BMD testing and/or osteoporosis treatment initiation (RD = 40%; 95% CI: 32–48%) for high-risk patients following intervention. Multifaceted interventions targeting high-risk patients and their primary care providers may improve the management of osteoporosis, but improvements are often clinically modest.


Meta-analysis Osteoporosis Prevention Primary care Systematic review 



Marie-Claude Laliberté is supported by a doctoral research award from the Canadian Institutes of Health Research (CIHR) in partnership with Osteoporosis Canada. Lyne Lalonde and Sylvie Perreault are research scholars who receive financial support from the Fonds de recherche en santé du Québec (FRSQ). We thank Ms. Monique Clar and Mr. Patrice Dupont of the Université de Montréal for their help with search strategies in electronic databases. We also thank Sarah-Gabrielle Béland, Élisabeth Martin, and Mélina Marin-Leblanc for their help with eligibility-criteria assessment. Thanks to Lise Lévesque for her help with eligibility-criteria assessment and with the Chronic Care Model elements.

Financial disclosure


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • M.-C. Laliberté
    • 1
    • 2
  • S. Perreault
    • 1
    • 3
  • G. Jouini
    • 1
    • 2
  • B. J. Shea
    • 4
  • L. Lalonde
    • 1
    • 2
    • 5
  1. 1.Faculty of PharmacyUniversité de MontréalMontrealCanada
  2. 2.Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de LavalCité-de-la-Santé HospitalLavalCanada
  3. 3.Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of PharmacyUniversité de MontréalMontrealCanada
  4. 4.Community Information and Epidemiological TechnologiesInstitute of Population HealthOttawaCanada
  5. 5.Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of PharmacyUniversité de MontréalMontrealCanada

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