Skip to main content

Advertisement

SpringerLink
Log in

Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

This study evaluated the effect of a multifaceted intervention (screening and patient education) by community pharmacists on testing or treatment of osteoporosis. One hundred and twenty-nine patients randomized to receive the intervention were compared to 133 patients who did not receive the intervention. Twice as many patients who got the intervention received further testing or treatment for osteoporosis.

Introduction

The objective of this study was to determine the effect of a community pharmacist screening program on testing and treatment of osteoporosis.

Methods

In this randomized, controlled trial, 262 patients meeting bone mineral density (BMD) testing guidelines [men or women aged ≥ 65 years or 50–64 years with one major risk factor including previous fracture, family history of osteoporosis, glucocorticoids for > 3 months, or early menopause] were allocated to intervention (129) or control (133). Intervention consisted of printed materials, education, and quantitative ultrasound. Primary outcome was a composite endpoint of BMD or prescription for osteoporosis medication within 4 months.

Results

Primary endpoint of BMD or osteoporosis treatment was achieved by 28 intervention patients (22%) compared with 14 controls (11%) (RR 2.1, 95% CI 1.1–3.7). This was driven by BMD testing (28 (22%) vs. 13 (10%) for controls, p = 0.011). Calcium intake increased more among intervention patients than controls (30% vs. 19%, RR 1.6, 95% CI 1.0–2.5). There was no effect on knowledge or quality of life.

Conclusion

A pharmacist screening program doubled the number of patients tested for osteoporosis. Nevertheless, many patients eligible for BMD did not receive appropriate care suggesting more intensive interventions are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Brown JP, Josse RG (2002) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167(10 suppl):S1–S34

    PubMed  Google Scholar 

  2. Papadimitopoulos EA (1997) Current and projected rates of hip fracture in Canada. CMAJ 157(10):1357–1363

    Google Scholar 

  3. Cummings SR, Kelsey JL, Nevitt M, O’Dowd K (1985) Epidemiology of osteoporosis and osteoporotic fracture. Epidemiol Rev 7:178–208

    CAS  PubMed  Google Scholar 

  4. Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S

    Article  CAS  PubMed  Google Scholar 

  5. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, Berger ML, Santora AC, Sherwood LM (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. Results from the National Osteoporosis Risk Assessment. JAMA 286:2815–2822

    Article  CAS  PubMed  Google Scholar 

  6. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Jt Surg Am 82:1063–1070

    Google Scholar 

  7. Gallagher TC, Gerling O, Comite F (2002) Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med 162:450–456

    Article  PubMed  Google Scholar 

  8. Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz GH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057

    Article  PubMed  Google Scholar 

  9. Hutchison BG, Abelson J, Woodward CA, Norman G (1996) Preventive care and barriers to effective prevention; how do family physicians see it. Can Fam Physician 42:1693–1700

    CAS  PubMed  Google Scholar 

  10. Mazanec D (2004) Osteoporosis screening: time to take responsibility. Arch Intern Med 164:1047–1048

    Article  PubMed  Google Scholar 

  11. Lafata JE, Kolk D, Peterson EL, McCarthy BD, Weiss TW, Chen YT, Muma BK (2007) Improving osteoporosis screening: results from a randomized cluster trial. J Gen Intern Med 22:346–351

    Article  PubMed  Google Scholar 

  12. Solomon DH, Katz JN, Finkelstein JS, Polinski JM, Stedman M, Brookhart MA, Arnold M, Gauthier S, Avorn J (2007) Osteoporosis improvement: a large-scale randomized controlled trial of patient and primary care physician education. J Bone Miner Res 22:1808–1815

    Article  PubMed  Google Scholar 

  13. Curtis JR, Westfall AO, Allison AO, Becker A, Melton ME, Feeman A, Keife CI, MacArthur M, Ockershausen T, Stewart E, Weissman G, Saag KG (2007) Challenges in improving the quality of osteoporosis care for long-term glucocorticoid users. Arch Intern Med 167:591–596

    Article  PubMed  Google Scholar 

  14. Solomon DH, Polinski JM, Stedman M, Truppo C, Breiner L, Egan C, Jan S, Patel M, Weiss TW, Chen YT, Brookhart MA (2007) Improving care of patients at-risk for osteoporosis: a randomized controlled trial. J Gen Intern Med 22:362–367

    Article  PubMed  Google Scholar 

  15. Solomon DH, Finkelstein JS, Pollinski JM, Arnold M, Licari A, Cabral D, Canning C, Avorn J, Katz JN (2006) A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporosis Int 17:760–67

    Article  CAS  Google Scholar 

  16. Ciardulli LM (2003) Using health observances to promote wellness in community pharmacies. J Am Pharm Assoc 43(1):61–68

    Article  Google Scholar 

  17. Holdford D, Kennedy DT, Bernadella P, Small R (1998) Implementing disease management in community pharmacy practice. Clin Ther 20(2):328–339

    Article  CAS  PubMed  Google Scholar 

  18. Tsuyuki RT, Johnson JA, Teo KK, Simpson SH, Ackman ML, Biggs RS, Cave A, Chang WC, Dzavik V, Farris KB, Galvin D, Semchuk W, Taylor JG (2002) A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: The Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP). Arch Intern Med 162:1149–1155

    Article  PubMed  Google Scholar 

  19. Park JJ, Kelly P, Carter BL, Burgess PP (1996) Comprehensive pharmaceutical care in the chain setting. J Am Pharm Assoc 36:443–451

    Google Scholar 

  20. Pauley TR, Magee MJ, Curry JD (1995) Pharmacist-managed, physician directed asthma management program reduces emergency department visits. Ann Pharmacother 29:5–9

    CAS  PubMed  Google Scholar 

  21. Hatoum JT, Akhras K (1993) A 32-year literature review on the value and acceptance of ambulatory care provided by pharmacists. Ann Pharmacother 27:1106–1119

    CAS  PubMed  Google Scholar 

  22. Yuksel N, Majumdar SR, Biggs C, Tsuyuki RT (2006) Design of a randomized trial of a community pharmacist-initiated screening and intervention program for osteoporosis—The OsteoPharm Study. CPJ 139(2):50–51

    Google Scholar 

  23. National Committee for Quality Assurance (NCQA). HEDIS 2004. http://www.ncqa.org/Portals/0/HEDISQM/Archives/2004/HEDIS04Update_Final.pdf. Accessed March 20, 2008

  24. Ailinger RL, Emerson J (1998) Women’s knowledge of osteoporosis. Appl Nurs Res 11(3):111–114

    Article  CAS  PubMed  Google Scholar 

  25. Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 29:602–608

    Google Scholar 

  26. Lydick E, Zimmerman SI, Yawn B, Love B, Kleerekoper M, Ross P, Martin A, Holmes R (1997) Development and validation of a discriminative quality of life questionnaire for osteoporosis (the OPTQoL). J Bone Miner Res 12(3):456–463

    Article  CAS  PubMed  Google Scholar 

  27. Elliott ME, Meek PD, Knaus NL, Schill GR, Weinswig PA, Bohlman JP, Zimpel CL, Jensen BC, Walters DR, Sutters SL, Peterson AN, Peterson RM, Binkley NC (2002) Pharmacy-based bone mass measurement to assess osteoporosis risk. Ann Pharmacother 36:571–577

    Article  PubMed  Google Scholar 

  28. Naunton M, Peterson GR, Jones G (2006) Pharmacist-provided quantitative heel ultrasound for rural women at risk of osteoporosis. Ann Pharmacother 40:38–44

    PubMed  Google Scholar 

  29. Goode JV, Swiger K, Blumi BM (2004) Regional osteoporosis screening, referral, and monitoring program in community pharmacies: findings from project ImPACT: osteoporosis. J Am Pharm Assoc 44(2):152–160

    Article  Google Scholar 

  30. Bauer DC, Gluer CC, Cauley JA, Vogt TM, Ensrud KE, Genant HK, Black DM (1997) Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study, Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:629–634

    Article  CAS  PubMed  Google Scholar 

  31. Hans D, Dargent-Molina P, Schott AM, Sebert JL, Cormier C, Kotzki PO (1996) Ultrasonographic heel measurements to predict hip fractures in elderly women: the EPIDOS prospective study. Lancet 348:511–514

    Article  CAS  PubMed  Google Scholar 

  32. Dehart RM, Gonzalez EH (2005) Osteoporosis: point of care testing. Ann Pharmacother 38:473–481

    Google Scholar 

  33. Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymovich WP, Steiner IP, Harley CH, Wirzba BJ, Hanley DA, Blitz S, Russell AS (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Annals Intern Med 141:366–373

    Google Scholar 

  34. Majumdar SR, Johnson JA, McAlister FA, Bellerose D, Russel AS, Hanley DA, Morrish DW, Maksymovich WP, Rowe BH (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178(5):569–575

    PubMed  Google Scholar 

  35. Brooke RH, McGlynn EA, Cleary PD (1996) Quality of health care. Part 2: measurement quality of care. N Eng J Med 335:966–969

    Article  Google Scholar 

  36. Bliuc D, Ong CR, Eisman JA, Center JR (2005) Barriers to effective management of osteoporosis in moderate and minimal trauma fractures: a prospective study. Osteoporosis Int 16(8):977–982

    Article  Google Scholar 

  37. Teng GG, Warriner A, Curtis JR, Saag KG (2008) Improving quality of care in osteoporosis: opportunities and challenges. Curr Rheumatol Rep 10(2):123–130

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Gary Jung, Ralph Lai, Denise Batiuk, Sammy Lee, Save On Foods Pharmacy Managers, support staff, and the many pharmacists who participated in this study. Additionally, we thank Sipi Garg for conducting the statistical analyses and the staff at the Epidemiology Coordinating and Research Center (EPICORE) Center of the University of Alberta for trial coordination and data management. This study was supported by a grant from the Institute of Health Economics (Edmonton) and Faculty Start Up Grant to Nesé Yuksel from the Faculty of Pharmacy and Pharmaceutical Sciences (University of Alberta). Sumit Majumdar receives salary support from Alberta Heritage Foundation for Medical Research [Health Scholar] and Canadian Institute of Health Research [New Investigator]. Ross Tsuyuki is supported by a University of Alberta research chair in Patient Health Management funded by Merck Frosst Canada Inc.

Conflicts of interest

None for Nese Yuksel, Sumit Majumdar, Catherine Biggs. Ross Tsuyuki has received grants from Apotex, AstraZeneca, Bayer, Bristol-Meyers Squibb, Merck Frosst, Pfizer, and Sanofi-Aventis.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3126 Dentistry/Pharmacy Centre, Edmonton, AB, T6G 2N8, Canada

    N. Yuksel

  2. Department of Medicine, University of Alberta, 2E7.07 Walter Mackenzie Health Sciences Center, 8440-112 St, Edmonton, AB, T6G 2B7, Canada

    S. R. Majumdar

  3. Centre for Community Pharmacy Research and Interdisciplinary Strategies (COMPRIS), EPICORE Centre, Suite 220, College Plaza, Edmonton, AB, T6G 2C8, Canada

    C. Biggs

  4. Department of Medicine, University of Alberta, EPICORE Centre, Suite 220, College Plaza, Edmonton, AB, T6G 2C8, Canada

    R. T. Tsuyuki

Authors
  1. N. Yuksel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. R. Majumdar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Biggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. T. Tsuyuki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. Yuksel.

Additional information

Trial Registry: ISRCTN 54746861

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yuksel, N., Majumdar, S.R., Biggs, C. et al. Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial. Osteoporos Int 21, 391–398 (2010). https://doi.org/10.1007/s00198-009-0977-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-009-0977-z

Keywords

Search

Navigation