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Complex interventions can increase osteoporosis investigations and treatment: a systematic review and meta-analysis

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Abstract

Osteoporosis is affecting over 200 million people worldwide. Despite available guidelines, care for these patients remains sub-optimal. We developed an osteoporosis tool to address the multiple dimensions of chronic disease management. Findings from its evaluation showed a significant increase from baseline in osteoporosis investigations and treatment, so we are revising this tool to include multiple chronic conditions including an update of evidence about osteoporosis. Our objectives were to conduct a systematic review of osteoporosis interventions in adults at risk for osteoporosis. We searched bibliometric databases for randomized controlled trials (RCTs) in any language evaluating osteoporosis disease management interventions in adults at risk for osteoporosis. Reviewer pairs independently screened citations and full-text articles, extracted data, and assessed risk of bias. Analysis included random effects meta-analysis. Primary outcomes were osteoporosis investigations and treatment, and fragility fractures. Fifty-five RCTs and one companion report were included in the analysis representing 165,703 patients. Our findings from 55 RCTs and 18 sub-group meta-analyses showed that complex implementation interventions with multiple components consisting of at least education + feedback + follow-up significantly increased the initiation of osteoporosis medications, and interventions with at least education + follow-up significantly increased the initiation of osteoporosis investigations. No significant impact was found for any type of intervention to reduce fracture. Complex interventions that include at least education + follow-up or feedback have the most potential for increasing osteoporosis investigations and treatment. Patient education appears to be an important component in osteoporosis disease management.

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Abbreviations

BMD:

bone mineral density

CI:

confidence interval

DXA:

dual-energy x-ray absorptiometry

EBM:

evidence-based medicine

FRAX:

fracture risk assessment tool

ICC:

interclass correlation coefficient

ITT:

intention to treat

NHS:

National Health Service

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analysis

QOL:

quality of life

QUS:

quantitative ultrasound

RB:

relative benefit

RCT:

randomized controlled trial

ROB:

risk of bias

RR:

relative risk

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Acknowledgements

MK is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award; SES is funded by a Tier 1 Canada Research Chair in Knowledge Translation. SEPM has received support from a Heart and Stroke Foundation of Canada Focus on Stroke Fellowship and is supported by the Toronto Rehabilitation Institute-University Health Network and a CIHR Fellowship.

Funding

This study did not receive any external funding.

Author information

Authors and Affiliations

  1. Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, Canada

    M. Kastner, J. Hamid, V. Treister, J. Chan, Y. Lai & S. E. Straus

  2. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    M. Kastner & C. C. Adhihetty

  3. Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada

    L. Perrier

  4. Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada

    S. E. P. Munce

  5. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

    A. Lau & S. E. Straus

  6. Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

    J. Hamid

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  1. M. Kastner
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Correspondence to M. Kastner.

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Kastner, M., Perrier, L., Munce, S.E.P. et al. Complex interventions can increase osteoporosis investigations and treatment: a systematic review and meta-analysis. Osteoporos Int 29, 5–17 (2018). https://doi.org/10.1007/s00198-017-4248-0

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