Clinical Decision Support Tools for Osteoporosis Disease Management: A Systematic Review of Randomized Controlled Trials
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.
Key Wordsosteoporosis disease management decision making randomized controlled trials
- 3.National Osteoporosis Society. Available at: http://www.nos.org.uk/: Accessed September, 2008.
- 4.Osteoporosis Canada. Available at: http://www.osteoporosis.ca/english/home/: Accessed September, 2008.
- 9.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.Google Scholar
- 12.International Osteoporosis Foundation. Available at: http://www.iofbonehealth.org/facts-and-statistics.html: Accessed September 2008.
- 14.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.
- 15.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.Google Scholar
- 17.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.Google Scholar
- 18.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.Google Scholar
- 19.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.Google Scholar
- 21.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.Google Scholar
- 22.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.Google Scholar
- 24.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.PubMedCrossRefGoogle Scholar
- 29.Egger M, Smith GD, Altman DG. Systematic reviews in health care: Meta-analysis in context. London: BMJ Publishing Group; 2001:309–10;395–6.Google Scholar
- 33.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.Google Scholar
- 43.Allen ML, Wyatt LE. Guidelines for the diagnosis, screening, and treatment of osteoporosis in women. Adv Studies Med. 2005;5(10):518–23.Google Scholar
- 44.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.Google Scholar
- 47.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.Google Scholar
- 48.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.Google Scholar
- 49.Bonaiuti D, Cranney A, Iovine R, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev. 2002;(3):CD000333.Google Scholar
- 50.Boulos P, Adachi JD. Guidelines for the prevention and therapy of glucocorticoid-induced osteoporosis. Clin Exp Rheumatol. 2000;18(Suppl 21):S79–86.Google Scholar
- 60.Josse R, Tenengouse AM, Hanley DA, et al. Clinical practice guidelines for the diagnosis and management of osteoporosis. CMAJ. 1996;155(8):1113–29.Google Scholar
- 62.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.Google Scholar
- 64.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.Google Scholar