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Table 3 Reported study outcomes

From: A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis

Reference   Reported study outcomes Osteoporosis medication use Comments
Gardner 2005 [46]   Control Intervention Post-intervention RD Δ Drugs used  
   N (%) N (%) (%) Bisphosphonates.  
  BMD scan 6/36 (17) 12/36 (33) 17 Data source for drug utilisation  
  Osteoporosis treatment 6/36 (17) 10/36 (28) 11 Patient self-report.  
Feldstein 2006 [47]   Control Intervention Post-intervention RD Drugs used Secondary outcomes included regular physical activity, total caloric expenditure, total calcium intake and patient satisfaction.
   N (%) N (%) (%) Bisphosphonate, calcitonin, selective estrogen receptor modulator, estrogen medication.  
  EMR     Data source for drug utilisation  
  BMD scan 2/101 (2) 40/101 (40)* 38 Electronically from outpatient pharmacy system.  
  Osteoporosis treatment 5/101 (5) 28/101 (28)* 23   No significant differences between the EMR and the EMR + patient reminder arm with respect to BMD scanning and osteoporosis treatment.
  EMR + patient reminder      
  BMD scan 2/101 (2) 36/109 (33)* 31   
  Osteoporosis treatment 5/101 (5) 22/109 (20)* 15   
Davis 2007 [48]   Control Intervention Post-intervention RD Drugs used 4/20 (20%) of the control group and 11/28 (39%) of the intervention group received a diagnosis of osteoporosis but this difference was not significant.
   N (%) N (%) (%) Bisphosphonates.  
  BMD scan 0/20 (0) 8/28 (29)* 29 Data source for drug utilisation  
  Osteoporosis treatment 0/20 (0) 15/28 (54)* 54 Patient self-report.  
  Calcium + vitamin D 6/20 (30) 11/28 (39) 9   
  Exercise prescription 0/20 (0) 9/28 (32)* 32   
Majumdar 2007 [49]   Control Intervention Post-intervention RD Drugs used Secondary outcomes included "appropriate care" (BMD testing with treatment if bone mass low), recurrent fractures, admissions to hospital and death.
   N (%) N (%) (%) Bisphosphonates - alendronate or risedronate. Of 120 who underwent BMD testing, 25 (21%) did not have low bone mass. Of the 95 patients with low bone mass, 41 (43%) had a T score at hip or spine between -1.5 and -2.5, and 54 (57%) had a T score of ≤ -2.5.
  BMD scan 32/110 (29) 88/110 (80)* 51 Data source for drug utilisation  
  Osteoporosis treatment 24/110 (22) 56/110 (51)* 29 Not reported.  
Solomon 2007 [50]   Control Intervention Post-intervention RD Drugs used Only results adjusted for baseline characteristics significant, unadjusted results insignificant.
   N (%) N (%) (%) HRT, calcitonin, raloxifene, bisphosphonates, teriparatide.  
  BMD scan 4/95 (4) 11/134 (8)* 4 Data source for drug utilisation  
  Osteoporosis treatment 1/95 (1) 6/134 (4) 3 Health-care utilisation data.  
Cranney 2008 [51]   Control Intervention Post-intervention RD Drugs used 38/141 (27%) of control patients and 43/120 (36%)of intervention patients received calcium or vitamin D. This difference was not statistically significant.
   N (%) N (%) (%) One patient raloxifene, 49 bisphosphonates. Results for osteoporosis treatment reported for all patients randomised (270) whereas BMD scanning and calcium or vitamin D only reported for those completing follow up (261).
  BMD scan 36/141 (26) 64/120 (53)* 28 Data source for drug utilisation Secondary outcomes included discussion with PCP regarding osteoporosis and changes in the participant's knowledge of osteoporosis.
  Osteoporosis treatment 15/145 (10) 35/125 (28)* 18 Patient self-report. Although baseline BMD scanning was reported, the ARD cannot be calculated as the numbers at baseline were different to those included in the analysis.
Majumdar 2008 [52]   Control Intervention Post-intervention RD Drugs used 58/135 (43%) of control patients and 91/137 (66%) of intervention patients received calcium and vitamin D. This difference was statistically significant.
   N (%) N (%) (%) Bisphosphonates. Results adjusted for acid peptic disease, osteoarthritis, current smoking, calcium and vitamin D use as significant differences found between intervention and control groups for these 5 variables.
  BMD scan 24/135 (18) 71/137 (52)* 34 Data source for drug utilisation Secondary outcomes included "appropriate care" and quality of life.
  Osteoporosis treatment 10/135 (7) 30/137 (22)* 14 Patient self-report confirmed through dispensing records of local pharmacies. Of the 95 patients who underwent BMD testing, 27 (28%) had normal bone mass, 49 (52%) had osteopenia (T score -1.0 to - 2.5), and 19 (20%) had osteoporosis (T score ≤ -2.5) at either the hip or spine.
Miki 2008 [53]   Control Intervention Post-intervention RD Drugs used No p-value given for difference in BMD scanning between groups.
   N (%) N (%) (%) One patient calcitonin nasal spray, 21 bisphosphonates. For those starting osteoporosis treatment the post-intervention RD was 44% but one patient in the control group and five in the intervention group stopped before six months.
  BMD scan 7/24 (29) 26/26 (100) 71 Data source for drug utilisation In the intervention group, 38% of those receiving treatment for osteoporosis had at least one T score of less than -2.5.
  Osteoporosis treatment 7/24 (29) 15/26 (58)* 29 Patient self-report. Although baseline BMD scanning was reported, the ARD cannot be calculated as the numbers at baseline were different to those included in the analysis.
       Secondary outcomes included new fracture during the six month follow up period.
Rozental 2008 [54]   Control (Intervention two) Intervention One Post-intervention RD Drugs used Intervention two sufficiently close to usual care as to be considered as the control group.
   N (%) N (%) (%) One teriparatide, one calcitonin, 11 bisphosphonates.  
  BMD scan 7/23 (30) 25/27 (93)* 62 Data source for drug utilisation 4/23 (17%) of control patients and 15/27 (56%) of intervention patients received calcium and vitamin D. This difference was not statistically significant.
  Osteoporosis treatment 5/23 (22) 8/27 (30) 8 Patient self-report and review of medical records. Calcium and vitamin D counted as osteoporosis treatment in original paper so post-intervention RD reported here substantially less (8% c.f. 48%). There was a significant difference between groups when calcium and vitamin D were included as osteoporosis treatment but no p-values reported with these excluded.
  Treatment discussed with PCP 8/23 (35) 24/27 (89)* 54   2/23 (9%) of patients in the control group and 9/27 (33%) of patients in the intervention group received a diagnosis of osteoporosis.
  1. *statistically significant difference between groups (p < 0.05).
  2. ΔRD = risk difference.