Osteoporosis International

, Volume 21, Issue 2, pp 307–319

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

DOI: 10.1007/s00198-009-0966-2

Cite this article as:
Kingwell, E., Prior, J.C., Ratner, P.A. et al. Osteoporos Int (2010) 21: 307. doi:10.1007/s00198-009-0966-2



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.


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.


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.


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.


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.


BMD Communication Epidemiology Fracture Men Women 

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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