Bone mineral density (BMD) peaks in early adulthood and declines progressively with aging. As BMD declines from normal, to low (formerly called osteopenia), to osteoporosis, risk of fractures progressively increases. In an effort to prevent bone loss and reduce fracture risk, most widely accepted guidelines including the U.S. Preventive Services Task Force and Surgeon General's Office now recommend BMD screening of older adults using dual energy x-ray absorptiometry (DXA). The rationale for screening is that patients and their providers will use DXA results as a "cue to action" and take necessary steps to enhance bone health through lifestyle modification (e.g., weight bearing exercise), Calcium/Vitamin D supplementation, and pharmacotherapy when indicated. However, multiple studies have demonstrated that patients and providers often fail take recommended actions following DXA testing, thus defeating much of the purpose of screening. Over the past five years we have systematically developed and pilot tested a low-cost and practical patient activation intervention based upon the Health Belief Model. The intervention consists of the DXA scanning center mailing each patient a customized letter containing the results of their DXA scan plus educational information about osteoporosis, supplemented by a follow-up phone call from a nurse educator. Preliminary studies have demonstrated that the intervention is well received by both patients and providers and enhances bone-related quality of care. The overarching objective of the current proposal is to rigorously examine the impact of our patient activation intervention on bone-related quality of care in adults undergoing screening DXA scans through a randomized-controlled trial conducted at three study sites. In addition, we will examine the real-world costs associated with our intervention and the impact of our intervention on the overall cost-effectiveness of BMD screening. We hypothesize that the activation intervention will increase optimization of Calcium/Vitamin D intake, enhance use of pharmacotherapy when indicated, will improve patient satisfaction with their bone-related healthcare, and improve patients'osteoporosis specific knowledge when compared with usual care.

Public Health Relevance

There is growing evidence that patients undergoing bone mineral density testing (BMD) often do not take important steps to improve their bone health. We will conduct a randomized-controlled trial to evaluate the impact of a novel and practical patient activation intervention (mailing patients their bone density test results) on the quality of bone-related healthcare and the cost-effectiveness of BMD testing. Equally important, our intervention could easily be modified to include other patient populations and chronic diseases.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
Project #
Application #
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Hannah, Judy S
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Iowa
Internal Medicine/Medicine
Schools of Medicine
Iowa City
United States
Zip Code
Cram, Peter (2014) CORR Insights®: the National Hospital Discharge Survey and the Nationwide Inpatient Sample: the databases used affect results in THA research. Clin Orthop Relat Res 472:3450-1
Pugely, Andrew J; Lu, Xin; Amendola, Annunziato et al. (2014) Trends in the use of total ankle replacement and ankle arthrodesis in the United States Medicare population. Foot Ankle Int 35:207-15
Singh, Jasvinder A; Lu, Xin; Rosenthal, Gary E et al. (2014) Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data. Ann Rheum Dis 73:2107-15
Cram, Peter; Bozic, Kevin J; Callaghan, John J et al. (2014) Use of present-on-admission indicators for complications after total knee arthroplasty: an analysis of Medicare administrative data. J Arthroplasty 29:923-928.e2
Hanmer, Janel; Lu, Xin; Rosenthal, Gary E et al. (2014) Insurance status and the transfer of hospitalized patients: an observational study. Ann Intern Med 160:81-90
Li, Yue; Cai, Xueya; Mukamel, Dana B et al. (2013) Impact of length of stay after coronary bypass surgery on short-term readmission rate: an instrumental variable analysis. Med Care 51:45-51
Li, Yue; Lu, Xin; Wolf, Brian R et al. (2013) Variation of Medicare payments for total knee arthroplasty. J Arthroplasty 28:1513-20
Miller, Benjamin J; Lu, Xin; Cram, Peter (2013) The trends in treatment of femoral neck fractures in the Medicare population from 1991 to 2008. J Bone Joint Surg Am 95:e132
Rosenthal, Jaime A; Lu, Xin; Cram, Peter (2013) Availability of consumer prices from US hospitals for a common surgical procedure. JAMA Intern Med 173:427-32
Edmonds, Stephanie W; Wolinsky, Fredric D; Christensen, Alan J et al. (2013) The PAADRN study: a design for a randomized controlled practical clinical trial to improve bone health. Contemp Clin Trials 34:90-100

Showing the most recent 10 out of 19 publications