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Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis

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Abstract

This study aims to evaluate the effectiveness of primary care interventions to improve the detection and treatment of osteoporosis. Eight electronic databases and six gray literature sources were searched. Randomized controlled trials, controlled clinical trials, quasi-randomized trials, controlled before–after studies, and interrupted time series written in English or French from 1985 to 2009 were considered. Eligible studies had to include patients at risk (women ≥ 65 years, men ≥ 70 years, and men/women ≥ 50 years with at least one major risk factor for osteoporosis) or at high risk (men/women using oral glucocorticoids or with previous fragility fractures) for osteoporosis and fractures. Outcomes included bone mineral density (BMD) testing, osteoporosis treatment initiation, and fractures. Data were pooled using a random effects model when applicable. Thirteen studies were included. The majority were multifaceted and involved patient educational material, physician notification, and/or physician education. Absolute differences in the incidence of BMD testing ranged from 22% to 51% for high-risk patients only and from 4% to 18% for both at-risk and high-risk patients. Absolute differences in the incidence of osteoporosis treatment initiation ranged from 18% to 29% for high-risk patients only and from 2% to 4% for at-risk and high-risk patients. Pooling the results of six trials showed an increased incidence of osteoporosis treatment initiation (risk difference (RD) = 20%; 95% CI: 7–33%) and of BMD testing and/or osteoporosis treatment initiation (RD = 40%; 95% CI: 32–48%) for high-risk patients following intervention. Multifaceted interventions targeting high-risk patients and their primary care providers may improve the management of osteoporosis, but improvements are often clinically modest.

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Acknowledgments

Marie-Claude Laliberté is supported by a doctoral research award from the Canadian Institutes of Health Research (CIHR) in partnership with Osteoporosis Canada. Lyne Lalonde and Sylvie Perreault are research scholars who receive financial support from the Fonds de recherche en santé du Québec (FRSQ). We thank Ms. Monique Clar and Mr. Patrice Dupont of the Université de Montréal for their help with search strategies in electronic databases. We also thank Sarah-Gabrielle Béland, Élisabeth Martin, and Mélina Marin-Leblanc for their help with eligibility-criteria assessment. Thanks to Lise Lévesque for her help with eligibility-criteria assessment and with the Chronic Care Model elements.

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None.

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada

    M.-C. Laliberté, S. Perreault, G. Jouini & L. Lalonde

  2. Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Cité-de-la-Santé Hospital, 1755 René-Laennec Blvd., room D-S080, Laval, QC, H7M 3L9, Canada

    M.-C. Laliberté, G. Jouini & L. Lalonde

  3. Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada

    S. Perreault

  4. Community Information and Epidemiological Technologies, Institute of Population Health, Ottawa, ON, Canada

    B. J. Shea

  5. Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada

    L. Lalonde

Authors
  1. M.-C. Laliberté
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  2. S. Perreault
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  3. G. Jouini
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  5. L. Lalonde
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Corresponding author

Correspondence to L. Lalonde.

Appendices

Appendix A. MEDLINE search strategy (Ovid SP)

  1. 1.

    osteoporosis/or osteoporosis, postmenopausal/

  2. 2.

    osteoporos#s.mp.

  3. 3.

    1 or 2

  4. 4.

    intervention$.mp.

  5. 5.

    education, medical/or education, medical, continuing/or education, nursing/or education, nursing, continuing/or education, pharmacy/or education, pharmacy, continuing/

  6. 6.

    health education/or patient education as topic/

  7. 7.

    health promotion/

  8. 8.

    education.mp.

  9. 9.

    "Referral and Consultation"/

  10. 10.

    Reminder Systems/

  11. 11.

    reminder$.mp.

  12. 12.

    prompt$.mp.

  13. 13.

    academic detailing$.mp.

  14. 14.

    audit$.mp.

  15. 15.

    feedback/or feedback$.mp.

  16. 16.

    alert$.mp.

  17. 17.

    Mass Screening/or screening*.mp.

  18. 18.

    risk assessment/or (risk$1 adj3 assessment$).mp. or (risk$1 adj3 estimat$).mp.

  19. 19.

    workshop$.mp.

  20. 20.

    ((improv$ or increas$) and (rate$ adj4 (testing or treatment or care))).mp.

  21. 21.

    ((improv$ or increas$) adj5 diagnos$).mp.

  22. 22.

    or/4–21

  23. 23.

    Physician's Practice Patterns/

  24. 24.

    health personnel/or exp allied health personnel/or health educators/or exp nurses/or exp nursing staff/or pharmacists/or physicians/or physicians, family/or family practice.mp.

  25. 25.

    (physician$ or nurs$ or pharmac$ or primary care or (care adj3 provider$)).mp.

  26. 26.

    Patients/

  27. 27.

    ((patient$ or participant$ or wom#n or men or man) and educat$).mp.

  28. 28.

    pharmacies/or Community Pharmacy Services/

  29. 29.

    or/23–28

  30. 30.

    3 and 22 and 29

  31. 31.

    limit 30 to "middle aged (45 plus years)"

  32. 32.

    limit 31 to yr = "1985-Current"

  33. 33.

    randomized controlled trial.pt.

  34. 34.

    random$.tw.

  35. 35.

    control$.tw.

  36. 36.

    intervention$.tw.

  37. 37.

    evaluat$.tw.

  38. 38.

    or/33–37

  39. 39.

    animal/

  40. 40.

    human/

  41. 41.

    39 not (39 and 40)

  42. 42.

    38 not 41

  43. 43.

    32 and 42

Appendix B. List of excluded studies

Table 7 List of excluded studies
Full size table

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Laliberté, MC., Perreault, S., Jouini, G. et al. Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis. Osteoporos Int 22, 2743–2768 (2011). https://doi.org/10.1007/s00198-011-1557-6

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  • DOI: https://doi.org/10.1007/s00198-011-1557-6

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