Table 3 Reported study outcomes

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.