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Education and Phone Follow-Up in Postmenopausal Women at Risk for Osteoporosis

Effects on Calcium Intake, Exercise Frequency, and Medication Use

  • Original Research Article
  • Published:
Disease Management and Health Outcomes

Abstract

Introduction

Postmenopausal osteoporosis remains a substantially underdiagnosed and undertreated disease. There is a lack of knowledge among older individuals of the appropriate measures to slow or prevent bone mineral density (BMD) loss, particularly in regard to their own personal risk of osteoporosis. Bone densitometry combined with education about osteoporosis improves self-reported daily calcium intake and utilization of hormone replacement therapy (HRT). This prospective unblinded randomized controlled trial was undertaken to determine the effect of nurse education plus follow-up phone care on initiation of and persistence with antiresorptive drug therapy, increases in calcium intake, and increases in weight-bearing exercise in postmenopausal women at high risk for osteoporosis, independent of bone densitometry testing.

Methods

The target study population was female patients of a large, multispecialty community practice aged ≥50 years. Study participants were not on HRT or antiresorptive drug therapy, were ≥5 years post menopause, had a score of ≥8 on the Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire. A total of 310 patients were enrolled and 287 (92.9%) completed the study. Participants underwent bone densitometry at study entry. They were then randomly assigned to one of two groups: (i) the usual care group who were given two educational brochures regarding osteoporosis; and (ii) the nurse education group who received these brochures plus a 15 minute one-on-one education regarding osteoporosis with a nurse. Both groups were told to follow up with their primary care physician. Those receiving nurse education also had telephone follow-up with the nurse educator at 3, 6, and 9 months. Telephone surveys of all participants were performed at 12 months after bone densitometry to assess self-reported initiation of and persistence with antiresorptive drug therapy after bone densitometry, self-reported changes in calcium intake, and weight-bearing exercise habits.

Results

Nurse education plus phone care follow-up had no effect on commencement of antiresorptive drug therapy (odds ratio [OR] 1.18, 95% CI 0.69, 2.04) or persistence with antiresorptive drug therapy (OR 1.05, 95% CI 0.56, 1.97). Nurse education plus phone care follow-up was associated with improved self-reported calcium intake (OR 2.18, 95% CI 1.36, 3.49) and exercise frequency (OR 1.89, 95% CI 1.11, 3.21).

Conclusion

Nurse education plus follow-up phone care does not improve utilization of drug therapy to prevent BMD loss or osteoporotic fracture, although it does improve the use of nonpharmacologic preventive measures for osteoporosis. Other strategies beyond patient education and follow-up phone care will be required to increase appropriate utilization of osteoporosis drug therapy.

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Acknowledgments

Funding support for this study was given by Merck and Co. Inc, West Point, Pennsylvania, USA. During the time of this study, Dr Abbott was with Outcomes Research and Management, Merck & Co. Inc., West Point, Pennsylvania, USA. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Authors and Affiliations

  1. Park Nicollet Health Services, Park Nicollet Osteoporosis Center, Park Nicollet Institute, Minneapolis, Minnesota, USA

    John T. Schousboe MD, MS (Director) & Rowan C. DeBold

  2. Park Nicollet Health Services, Park Nicollet Institute, Minneapolis, Minnesota, USA

    John T. Schousboe MD, MS (Director) & Linda S. Kuno

  3. Outcomes Research and Management, Merck and Co Inc, West Point, Pennsylvania, USA

    Thomas W. Weiss & Ya-Ting Chen

  4. Thomson Corporation, Philadelphia, Pennsylvania, USA

    Thomas A. Abbott III

Authors
  1. John T. Schousboe MD, MS
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  2. Rowan C. DeBold
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  3. Linda S. Kuno
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  4. Thomas W. Weiss
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  5. Ya-Ting Chen
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  6. Thomas A. Abbott III
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Correspondence to John T. Schousboe MD, MS.

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Schousboe, J.T., DeBold, R.C., Kuno, L.S. et al. Education and Phone Follow-Up in Postmenopausal Women at Risk for Osteoporosis. Dis-Manage-Health-Outcomes 13, 395–404 (2005). https://doi.org/10.2165/00115677-200513060-00004

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