Background: Osteoporosis (Op) affects over 200 million people worldwide. Despite the existence of guidelines, care for these patients remains sub-optimal. We conducted a systematic review in 2006 to identify Op interventions to address these gaps, and found that those with multiple components had potential for impact, but it wasn’t clear which component contributed to their impact. We are updating a knowledge translation tool to address multi-morbidity (which includes Op), but we need to understand not just 'what' Op interventions work, but which of their elements contribute to their impact. Objectives: To determine the effectiveness of Op interventions (and which elements contribute to their impact) for improving Op disease management in adults at risk of Op. Methods: We searched MEDLINE, EMBASE, and CINAHL for RCTs in any language for Op interventions targeting postmenopausal women and men age ≥ 65 years. Interventions could involve ≥ 1 components (e.g. education, reminder) and delivered in any format. Two reviewers independently screened articles, extracted data, and assessed risk of bias. Primary outcomes were Op investigations and treatment. Analysis included exploration of statistical and methodological heterogeneity and meta-analysis, and identification of specific intervention elements contributing to the effectiveness of Op interventions.
Results: Preliminary findings identified 35 studies that met eligibility criteria. Of these, 15 were cluster RCTs where the unit of allocation was clinicians, primary practices and pharmacies. Intervention components were risk assessment (RA), education (ED), exercise (EX), reminder (REM), and feedback (FB), which were tested in multiple combinations and targets (i.e. patients, physicians, nurses, and pharmacists). Compared with controls, studies that comprise RA+ED+REM+FB significantly increased the initiation of Op medications (pooled relative risk (RR) 2.35, 95% confidence interval (CI) 1.69 to 3.26) and bone mineral density testing (pooled RR 2.10; CI 1.57 to 2.81). Conclusions: Our systematic review update indicates that Op interventions incorporating elements of RA, ED, REM, and FB improve disease management.