Osteoporosis International

, Volume 21, Issue 2, pp 307–319 | Cite as

Direct-to-participant feedback and awareness of bone mineral density testing results in a population-based sample of mid-aged Canadians

  • E. Kingwell
  • J. C. Prior
  • P. A. Ratner
  • S. M. Kennedy
Original Article

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.

Keywords

BMD Communication Epidemiology Fracture Men Women 

References

  1. 1.
    Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(10 Suppl):S1–S34PubMedGoogle Scholar
  2. 2.
    Siminoski K, Leslie WD, Frame H et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56(3):178–188PubMedGoogle Scholar
  3. 3.
    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 2004Google Scholar
  4. 4.
    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):990–995PubMedGoogle Scholar
  5. 5.
    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):2143–2149CrossRefPubMedGoogle Scholar
  6. 6.
    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 6:12CrossRefPubMedGoogle Scholar
  7. 7.
    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):1968–1973PubMedGoogle Scholar
  8. 8.
    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):323–330CrossRefPubMedGoogle Scholar
  9. 9.
    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):635–641CrossRefPubMedGoogle Scholar
  10. 10.
    Pimlott N (2008) Who has time for family medicine? Can Fam Physician 54(1):14–16PubMedGoogle Scholar
  11. 11.
    Ong LM, de Haes JC, Hoos AM, Lammes FB (1995) Doctor–patient communication: a review of the literature. Soc Sci Med 40(7):903–918CrossRefPubMedGoogle Scholar
  12. 12.
    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):584–590CrossRefPubMedGoogle Scholar
  13. 13.
    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):376–387Google Scholar
  14. 14.
    Tenenhouse A, Kreiger N, Hanley D (2000) Canadian Multicentre Osteoporosis Study (CaMos). Drug Dev Res 49:201–205CrossRefGoogle Scholar
  15. 15.
    Kanis JA, Melton LJ III, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141PubMedCrossRefGoogle Scholar
  16. 16.
    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):777–781PubMedGoogle Scholar
  17. 17.
    Pickney CS, Arnason JA (2005) Correlation between patient recall of bone densitometry results and subsequent treatment adherence. Osteoporos Int 16(9):1156–1160CrossRefPubMedGoogle Scholar
  18. 18.
    Tosteson AN, Grove MR, Hammond CS et al (2003) Early discontinuation of treatment for osteoporosis. Am J Med 115(3):209–216CrossRefPubMedGoogle Scholar
  19. 19.
    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):1306–1311CrossRefPubMedGoogle Scholar
  20. 20.
    Weinstein ND (1982) Unrealistic optimism about susceptibility to health problems. J Behav Med 5(4):441–460CrossRefPubMedGoogle Scholar
  21. 21.
    Weinstein ND (1989) Optimistic biases about personal risks. Science 246(4935):1232–1233CrossRefPubMedGoogle Scholar
  22. 22.
    Rimes KA, Salkovskis PM, Shipman AJ (1999) Psychological and behavioural effects of bone density screening for osteoporosis. Psychol Health 14:585–608CrossRefGoogle Scholar
  23. 23.
    Timko C, Janoff-Bulman R (1985) Attributions, vulnerability, and psychological adjustment: the case of breast cancer. Health Psychol 4(6):521–544CrossRefPubMedGoogle Scholar
  24. 24.
    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):460–473CrossRefPubMedGoogle Scholar
  25. 25.
    Sedlak CA, Doheny MO, Estok PJ (2000) Osteoporosis in older men: knowledge and health beliefs. Orthop Nurs 19(3):38–42CrossRefPubMedGoogle Scholar
  26. 26.
    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):898–905CrossRefPubMedGoogle Scholar
  27. 27.
    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):289–299PubMedGoogle Scholar
  28. 28.
    Melton LJ III, Atkinson EJ, Madhok R (1996) Downturn in hip fracture incidence. Public Health Rep 111(2):146–151PubMedGoogle Scholar
  29. 29.
    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):18–25CrossRefPubMedGoogle Scholar
  30. 30.
    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):893–899CrossRefPubMedGoogle Scholar
  31. 31.
    Kanis JA, Johnell O, De Laet C et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2):375–382CrossRefPubMedGoogle Scholar
  32. 32.
    Kanis JA, Johnell O, Oden A et al (2005) Smoking and fracture risk: a meta-analysis. Osteoporos Int 16(2):155–162CrossRefPubMedGoogle Scholar
  33. 33.
    FRAX WHO Fracture Risk Assessment Tool (2008) www.shef.ac.uk/FRAX/reference.htm. Accessed 28 July 2008
  34. 34.
    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):996–999PubMedGoogle Scholar
  35. 35.
    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):477–488CrossRefGoogle Scholar
  36. 36.
    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):87–93CrossRefPubMedGoogle Scholar
  37. 37.
    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):233–239CrossRefPubMedGoogle Scholar
  38. 38.
    Statistics Canada (2004) Statistics Canada 1996 census tables. www.statcan.gc.ca/c1996-r1996/nation-pays2-eng.htm. Accessed 18 December 2008
  39. 39.
    Looker AC, Wahner HW, Dunn WL et al (1998) Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int 8(5):468–489CrossRefPubMedGoogle Scholar
  40. 40.
    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):897–904CrossRefPubMedGoogle Scholar
  41. 41.
    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):585–590CrossRefPubMedGoogle Scholar
  42. 42.
    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):432–438CrossRefPubMedGoogle Scholar
  43. 43.
    Hanson J, Felsenberg D, Fuerst T et al (1997) Letter. Bone 21(4):369–370CrossRefGoogle Scholar
  44. 44.
    Papaioannou A, Giangregorio L, Kvern B, Boulos P, Ioannidis G, Adachi JD (2004) The osteoporosis care gap in Canada. BMC Musculoskelet Disord 5:11CrossRefPubMedGoogle Scholar
  45. 45.
    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):208–215CrossRefPubMedGoogle Scholar
  46. 46.
    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):293–305CrossRefPubMedGoogle Scholar
  47. 47.
    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 49:462–468PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • E. Kingwell
    • 1
    • 2
  • J. C. Prior
    • 2
  • P. A. Ratner
    • 3
  • S. M. Kennedy
    • 4
  1. 1.Division of Neurology, Department of MedicineUniversity of British ColumbiaVancouverCanada
  2. 2.Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, Department of MedicineUniversity of British Columbia, Gordon and Leslie Diamond CentreVancouverCanada
  3. 3.Centre for Nursing and Health Behaviour Research, School of NursingUniversity of British ColumbiaVancouverCanada
  4. 4.Department of Health Care and Epidemiology and School Environmental HealthUniversity of British ColumbiaVancouverCanada

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