Education and phone follow-up in postmenopausal women at risk for osteoporosis - Effects on calcium intake, exercise frequency, and medication use

Introduction: Postmenopausal osteoporosis remains a substantially underdiagnosed and undertreated disease. There is a lack of knowledge among older individuals of the appropriate measures to slow or prevent bone mineral density (BMD) loss, particularly in regard to their own personal risk of osteoporosis. Bone densitometry combined with education about osteoporosis improves self-reported daily calcium intake and utilization of hormone replacement therapy (HRT). This prospective unblinded randomized controlled trial was undertaken to determine the effect of nurse education plus follow-up phone care on initiation of and persistence with antiresorptive drug therapy, increases in calcium intake, and increases in weight-bearing exercise in postmenopausal women at high risk for osteoporosis, independent of bone densitometry testing. Methods: The target study population was female patients of a large, multispecialty community practice aged :50 years. Study participants were not on HRT or antiresorptive drug therapy, were >= 5 years post menopause, had a score of >= 8 on the Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire. A total of 3 10 patients were enrolled and 287 (92.9%) completed the study. Participants underwent bone densitometry at study entry. They were then randomly assigned to one of two groups: (i) the usual care group who were given two educational brochures regarding osteoporosis; and (ii) the nurse education group who received these brochures plus a 15 minute one-on-one education regarding osteoporosis with a nurse. Both groups were told to follow up with their primary care physician. Those receiving nurse education also had telephone follow-up with the nurse educator at 3, 6, and 9 months. Telephone surveys of all participants were performed at 12 months after bone densitometry to assess self-reported initiation of and persistence with antiresorptive drug therapy after bone densitometry, self-reported changes in calcium intake, and weight-bearing exercise habits. Results: Nurse education plus phone care follow-up had no effect on commencement of antiresorptive drug therapy (odds ratio [OR] 1.18, 95% Cl 0.69, 2.04) or persistence with antiresorptive drug therapy (OR 1.05, 95% Cl 0.56, 1.97). Nurse education plus phone care follow-up was associated with improved self-reported calcium intake (OR 2.18, 95% Cl 1.36, 3.49) and exercise frequency (OR 1.89, 95% Cl 1.11, 3.21). Conclusion: Nurse education plus follow-up phone care does not improve utilization of drug therapy to prevent BMD loss or osteoporotic fracture, although it does improve the use of nonpharmacologic preventive measures for osteoporosis. Other strategies beyond patient education and follow-up phone care will be required to increase appropriate utilization of osteoporosis drug therapy.