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A randomized controlled trial of mailed osteoporosis education to older adults

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Abstract

Introduction

Osteoporosis represents a growing public health concern; however, current rates of management are sub-optimal. The aim of our study was to assess, in a randomized controlled trial, the effect of a mailed educational intervention on older adults’ knowledge, attitudes, and preventive behaviors regarding osteoporosis. The setting was a large publicly funded state pharmacy benefits program. The patients were 31,715 Medicare beneficiaries from Pennsylvania who participated in a drug benefits program for low-to-moderate income elderly people.

Methods

All women aged over 65 years, and all men and women with a history of fracture or long-term oral use of glucocorticoid, were included. Approximately half of the participants (intervention group) were randomly selected to receive three mailings aimed at improving knowledge of osteoporosis and enhancing preventive activities, such as using calcium and vitamin D, reducing fall risks in the home, obtaining a bone mineral density (BMD) test, and taking medications when necessary. The other participants did not receive the intervention mailings and served as controls. We surveyed a sample of intervention and control subjects to determine the effects of the intervention on knowledge, attitudes, self-efficacy (confidence in one’s ability to perform specific activities), and behavior regarding osteoporosis prevention and treatment. Six hundred randomly selected participants in the intervention group and an equal number in the control group were invited to participate.

Results

Twenty-six had died and 636 of the remaining 1,185 (54%) completed the survey. Respondents and non-respondents did not differ significantly with respect to measured sociodemographic factors. All scales had good reliability (all Cronbach’s alphas >0.65). Knowledge of osteoporosis was generally very good and did not differ between intervention (mean = 65% correct responses) and control subjects (mean = 67% correct; P=0.4). Perceived susceptibility to osteoporosis was relatively high and similar across groups (P=0.4). Self-efficacy for participating in osteoporosis prevention and treatment was very strong in both the intervention (mean = 4.3 on a 0–5 scale) and control (mean = 4.2, P=0.03) groups . On average, subjects in the intervention group reported participating in 3.5 of 6 preventive osteoporosis activities compared with 3.4 in the control group (P=0.5).

Conclusions

Compared with the controls, a mailed educational intervention for osteoporosis was not associated with better knowledge, higher perceived susceptibility, or performance of preventive measures among the at-risk older adults that we studied. The intervention group demonstrated a small increase in self-efficacy. More intensive patient interventions or intervention aimed at other aspects of the care process may be required to bring about changes that lead to a reduction in fractures.

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Acknowledgments

The study was supported by the Arthritis Foundation (Atlanta Ga., USA), National Institutes of Health (K23 AR48616, R01 DA15507, R55 AR48264, K24 AR02123, P60 AR47782, K24 DK02759), and Engalitcheff Arthritis Outcomes Initiative (Baltimore, Md., USA)

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Authors and Affiliations

  1. Division of Pharmacoepidemiology, Brigham and Women’s Hospital, Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA

    D. H. Solomon, J. M. Polinski, M. Arnold, A. Licari, D. Cabral, C. Canning & J. Avorn

  2. Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    J. S. Finkelstein

  3. Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    D. H. Solomon & J. N. Katz

  4. Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    J. N. Katz

  5. Harvard School of Public Health, Boston, MA, USA

    M. Arnold

Authors
  1. D. H. Solomon
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  2. J. S. Finkelstein
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  3. J. M. Polinski
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  4. M. Arnold
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  5. A. Licari
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  6. D. Cabral
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  7. C. Canning
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  8. J. Avorn
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  9. J. N. Katz
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Corresponding author

Correspondence to D. H. Solomon.

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Solomon, D.H., Finkelstein, J.S., Polinski, J.M. et al. A randomized controlled trial of mailed osteoporosis education to older adults. Osteoporos Int 17, 760–767 (2006). https://doi.org/10.1007/s00198-005-0049-y

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  • DOI: https://doi.org/10.1007/s00198-005-0049-y

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