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)
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Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Hannah, Judy S
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University of Iowa
Internal Medicine/Medicine
Schools of Medicine
Iowa City
United States
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Roblin, Douglas W; Cram, Peter; Lou, Yiyue et al. (2018) Diet and exercise changes following bone densitometry in the Patient Activation After DXA Result Notification (PAADRN) study. Arch Osteoporos 13:4
Wolinsky, F D; Lou, Y; Edmonds, S W et al. (2017) The effects of a patient activation intervention on smoking and excessive drinking cessations: results from the PAADRN randomized controlled trial. Osteoporos Int 28:3055-3060
Wolinsky, F D; Hall, S F; Lou, Y et al. (2017) The cost of a patient activation intervention for achieving successful outcomes: results from the PAADRN randomized controlled trial. Osteoporos Int 28:3061-3066
Wolinsky, Fredric D; Lou, Yiyue; Edmonds, Stephanie W et al. (2017) Activating Patients With a Tailored Bone Density Test Results Letter and Educational Brochure: the PAADRN Randomized Controlled Trial. J Clin Densitom 20:464-471
Cram, Peter; Saag, Kenneth G; Lou, Yiyue et al. (2017) Racial Differences and Disparities in Osteoporosis-related Bone Health: Results From the PAADRN Randomized Controlled Trial. Med Care 55:561-568
Edmonds, Stephanie W; Solimeo, Samantha L; Nguyen, Vu-Thuy et al. (2017) Understanding Preferences for Osteoporosis Information to Develop an Osteoporosis Patient Education Brochure. Perm J 21:
Nguyen, V T; Edmonds, S W; Lou, Y et al. (2017) Validity, reliability, and responsiveness to change of the ""Osteoporosis and You"" knowledge scale. Osteoporos Int 28:3379-3388
Roblin, Douglas W; Zelman, David; Plummer, Sally et al. (2017) Evaluation of a ""Just-in-Time"" Nurse Consultation on Bone Health: A Pilot Randomized Controlled Trial. Perm J 21:
Hall, Sylvie F; Edmonds, Stephanie W; Lou, Yiyue et al. (2017) Patient-reported reasons for nonadherence to recommended osteoporosis pharmacotherapy. J Am Pharm Assoc (2003) 57:503-509
Cram, P; Wolinsky, F D; Lou, Y et al. (2016) Patient-activation and guideline-concordant pharmacological treatment after bone density testing: the PAADRN randomized controlled trial. Osteoporos Int 27:3513-3524

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