Over one-third of women over 65 and 15% of older men have osteoporosis. Untreated it can result in substantial morbidity, mortality, and costs, but there are effective pharmacologic and lifestyle interventions for preventing falls and fractures. There is evidence that these interventions are not reaching those most at risk. It is a critical public health issue to develop strategies to bring evidence-based interventions to widespread use in at-risk patients. To further his training in patient-oriented research, the candidate has proposed a research project with 3 aims. In the first aim, he will develop and pilot test osteoporosis fracture prevention behavior-change programs that target both patients and physicians. The growing public interest in osteoporosis and the potential to target patient communication based on prescribing and clinical data suggests the possibility for innovative interventions for fracture prevention. Additionally, interventions directed towards physicians that use patient-specific data and oneon-one academic detailing have proven successful at improving physician prescribing in many chronic medical conditions. Thus, he will develop and pilot test two osteoporosis prevention interventions: one targeting patients and another targeting doctors. In the second Aim, he will supervise a randomized controlled trial to compare the effects of the patient and physician intervention programs on prescribing patterns for osteoporosis. Over 20,000 patients and 200 physicians will be included in the trial through a collaboration developed with the Pennsylvania Department of Aging. Pharmacy claims data and information from Medicare will be used to target patient communications and to assess the effects of the program on prescribing. In the third Aim, he will examine the interventions effects on osteoporosis prevention behaviors other than medication use, including gait and strength training, home safety, vision care, and calcium and vitamin D intake. This will help determine whether differences in osteoporosis prevention behavior were mediated through the interventions effect on patient and/or physician attitudes, perceived behavioral control, and/or social norms regarding osteoporosis prevention. In addition to active involvement in these studies, the candidate has developed a coordinated training program in epidemiology, biostatistics, bone and mineral metabolism, and rheumatology. A multi-disciplinary Training Advisory Board will review the applicants progress regularly to ensure that the proposed training goals are met.
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