Archives of Osteoporosis

, 13:52 | Cite as

Promoting bone health management in women diagnosed with breast cancer: a pilot randomized controlled trial

  • Olivia L. TsengEmail author
  • John J. Spinelli
  • Carolyn C. Gotay
  • Wan Yu Ho
  • Mary L. McBride
  • Martin G. Dawes
Original Article



This study investigates, in women diagnosed with breast cancer, the feasibility of evaluating the effects of educational material and its delivery method, on bone health management. The study results suggest educational material may improve rates of bone mineral density testing.


Educational materials improve bone mineral density (BMD) testing rates in high-risk patients, but the effect is unknown in women diagnosed with breast cancer. Methods of delivering educational materials may also affect testing rates. The purposes of this study were to determine the feasibility of the protocol and to pilot-test the effects of educational material and its delivery methods on BMD testing rates.


Pilot randomized controlled trial with block randomization. Fifty-four women (aged 65–75 and diagnosed with breast cancer ≥ 3 years ago (2010–2012) and not taking osteoporosis medication) were recruited from February to May 2016 and randomized to three groups: control without educational material, educational material delivered by postal mail, and educational material delivered by patient choice of postal mail, email, or text messaging. Outcome measures were primarily evaluated using self-report questionnaires.


The participation rate, defined as the proportion of eligible participants who consented to participate, was 39.1%. Primary outcome measure was obtained for 98% of the recruited women. During the 6-month follow-up period, BMD testing rates were significantly higher in the groups receiving educational materials by mail (26%, 95%CI = 10 to 49) and by patient choice (18%, 95%CI = 5 to 41), when compared with the control group (6%, 95%CI = 0.3 to 25). Educational material was associated with a 17% higher BMD testing rate.


The study protocol is feasible for a large-scale study. The educational material intervention is broadly accepted by the study participants with a promising positive effect on BMD testing rates.


Educational material BMD testing rates Lifestyle Breast cancer Exercise Vitamin D Calcium Patient choice 



British Columbia


Bone Mineral Density


Calcium Assessment Tool


Confidence Interval


Dual energy X-ray absorptiometry


Fracture risk assessment tool


Godin Leisure-Time Exercise Questionnaire


Randomized Controlled Trial


Standard deviation


Vitamin D & Sun



The authors thank pharmacist Jin Qing Pan for reviewing medication dispensing records and the Centre of Excellence in Cancer Prevention, a partnership between the Canadian Cancer Society and the University of British Columbia’s School of Population and Public Health, for facilitating development of the educational material. The first author, Dr. Olivia L. Tseng, was financially supported by a Clinician Scholarship through the Department of Family Practice of University of British Columbia and a Roman M. Babicki Fellowship in Medical Research through the University of British Columbia.


This study was supported by Janus research Award from the College of Family Physicians Canada.

Compliance with ethical standards

Ethical approval

This study has been approved by the University of British Columbia/BC Cancer Agency Ethics Board (H15-00849).

Conflicts of interest


Supplementary material

11657_2018_469_MOESM1_ESM.docx (1010 kb)
ESM 1 (DOCX 1009 kb)
11657_2018_469_MOESM2_ESM.doc (218 kb)
ESM 2 (DOC 217 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Olivia L. Tseng
    • 1
    • 2
    Email author
  • John J. Spinelli
    • 1
    • 3
  • Carolyn C. Gotay
    • 1
    • 3
  • Wan Yu Ho
    • 4
  • Mary L. McBride
    • 1
    • 3
  • Martin G. Dawes
    • 2
  1. 1.Cancer Control Research ProgramBritish Columbia Cancer Agency (BCCA)VancouverCanada
  2. 2.Department of Family PracticeUniversity of British ColumbiaVancouverCanada
  3. 3.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  4. 4.Faculty of Pharmaceutical ScienceUniversity of Britissh ColumbiaVancouverCanada

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