Feedback of fracture risk based on bone mineral density (BMD) is an under-explored potential osteoporosis education intervention. We performed a randomised controlled trial of either an osteoporosis information leaflet or small group education (the Osteoporosis Prevention and Self-Management Course (OPSMC)), combined with individualised fracture risk feedback in premenopausal women over two years. Women with a mean T-score at spine and hip of < 0 were informed they were at higher risk of fracture in later life and those with T-score ≥ 0 were informed they were not. Women receiving feedback of high fracture risk had a greater increase in femoral neck, but not lumbar spine, BMD compared to the low risk group (1.6% p.a. vs. 0.7% p.a., p = 0.0001). Participation in the OPSMC had no greater effect on BMD than receiving the leaflet. Femoral neck BMD change was associated with starting calcium supplements (1.3% p.a., 95% CI +0.49, +2.17) and self-reported physical activity change (0.7% p.a., 95% CI +0.22, +1.22). Mother’s report of increasing their children’s calcium intake was associated with receiving the OPSMC (OR 2.3, 95% CI 1.4, 3.8) and feedback of high fracture risk (OR 2.0, 95% CI 1.2, 3.3). Fracture risk feedback based on BMD could potentially make an important contribution to osteoporosis prevention but confirmation of long-term benefits and cost effectiveness is needed before implementation can be recommended.
References
[1]
Britt, H.; Miller, G.; Charles, J.; Henderson, J.; Bayram, C.; Pan, Y.; Valenti, L.; Harrison, C.; Fahridin, S.; O’Halloran, J. General Practice Activity in Australia, 2008-09; General practice series no. 25. Cat. no. GEP 25; AIHW: Canberra, Australia, 2009.
[2]
Access Economics. The Burden of Brittle Bones: Costing Osteoporosis in Australia; Osteoporosis Australia: Sydney, Australia, 2001.
[3]
Pasco, J.A.; Sanders, K.M.; Hoekstra, F.M.; Henry, M.J.; Nicholson, G.C.; Kotowicz, M.A. The human cost of fracture. Osteoporos. Int.？2005, 16, 2046–2052.
[4]
Marshall, D.; Johnell, O.; Wedel, H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ？1996, 312, 1254–1259.
[5]
Nguyen, T.; Sambrook, P.; Kelly, P.; Jones, G.; Lord, S.; Freund, J.; Eisman, J. Prediction of osteoporotic fractures by postural instability and bone density. BMJ？1993, 307, 1111–1115.
[6]
Riis, B.J.; Hansen, M.A.; Jensen, A.M.; Overgaard, K.; Christiansen, C. Low bone mass and fast rate of bone loss at menopause: equal risk factors for future fracture: a 15-year follow-up study. Bone？1996, 19, 9–12.
[7]
Recker, R.R.; Davies, K.M.; Hinders, S.M.; Heaney, R.P.; Stegman, M.R.; Kimmel, D.B. Bone gain in young adult women. JAMA？1992, 268, 2403–2408.
[8]
Recker, R.; Lappe, J.; Davies, K.; Heaney, R. Characterization of perimenopausal bone loss: a prospective study. J. Bone Miner. Res.？2000, 15, 1965–1973.
[9]
Welten, D.C.; Kemper, H.C.; Post, G.B.; van Staveren, W.A. A meta-analysis of the effect of calcium intake on bone mass in young and middle aged females and males. J. Nutr.？1995, 125, 2802–2813.
[10]
Wolff, I.; van Croonenborg, J.J.; Kemper, H.C.; Kostense, P.J.; Twisk, J.W. The effect of exercise training programs on bone mass: a meta-analysis of published controlled trials in pre- and postmenopausal women. Osteoporos. Int.？1999, 9, 1–12.
[11]
Edwards, A.; Hood, K.; Matthews, E.; Russell, D.; Russell, I.; Barker, J.; Bloor, M.; Burnard, P.; Covey, J.; Pill, R.; Wilkinson, C.; Stott, N. The effectiveness of one-to-one risk communication interventions in health care: a systematic review. Med. Decis. Making？2000, 20, 290–297.
[12]
Torley, D.; Zwar, N.; Comino, E.J.; Harris, M. GPs’ views of absolute cardiovascular risk and its role in primary prevention. Aust. Fam. Physician？2005, 34, 503-504, 507.
[13]
Group, R.O.W. Clinical Guideline for the Prevention and Treatment of Osteoporosis in Postmenopausal Women and Older Men; Royal Australian College of General Practitioners: Melbourne, Australia, 2010.
[14]
Ewald, D.P.; Eisman, J.A.; Ewald, B.D.; Winzenberg, T.M.; Seibel, M.J.; Ebeling, P.R.; Flicker, L.A.; Nash, P.T. Population rates of bone densitometry use in Australia, 2001-2005, by sex and rural versus urban location. Med. J. Aust.？2009, 190, 126–128. 19203308
[15]
Cook, B.; Noteloviz, M.; Rector, C.; Krischer, J. An Osteoporosis Patient Education and Screening Program:Results and Implications. Patient Educ. Couns.？1991, 17, 135–145.
[16]
Jamal, S.A.; Ridout, R.; Chase, C.; Fielding, L.; Rubin, L.A.; Hawker, G.A. Bone mineral density testing and osteoporosis education improve lifestyle behaviors in premenopausal women: a prospective study. J. Bone Miner. Res.？1999, 14, 2143–2149.
[17]
Jones, G.; Scott, F. Low bone mass in premenopausal parous women: identification and the effect of an information and bone density feedback program. J. Clin. Densitom.？1999, 2, 109–115.
[18]
Winzenberg, T.M.; Oldenburg, B.; Frendin, S.; De Wit, L.; Jones, G. Effects of bone density feedback and group education on osteoporosis knowledge and osteoporosis self-efficacy in premenopausal women: a randomized controlled trial. J. Clin. Densitom.？2005, 8, 95–103.
[19]
Winzenberg, T.; Oldenburg, B.; Frendin, S.; De Wit, L.; Riley, M.; Jones, G. The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: a randomized controlled trial [NCT00273260]. BMC Public Health？2006, 6, 12.
[20]
Angus, R.M.; Sambrook, P.N.; Pocock, N.A.; Eisman, J.A. A simple method for assessing calcium intake in Caucasian women. J. Am. Diet. Assoc.？1989, 89, 209–214.
[21]
Aaron, D.J.; Kriska, A.M.; Dearwater, S.R.; Cauley, J.A.; Metz, K.F.; LaPorte, R.E. Reproducibility and validity of an epidemiologic questionnaire to assess past year physical activity in adolescents. Am. J. Epidemiol.？1995, 142, 191–201.
[22]
Jones, G.; Scott, F.S. A cross-sectional study of smoking and bone mineral density in premenopausal parous women: effect of body mass index, breastfeeding, and sports participation. J. Bone Miner. Res.？1999, 14, 1628–1633, doi:10.1359/jbmr.1999.14.9.1628. 10469293
[23]
Withers, R.T.; Davies, G.J.; Crouch, R.G. A comparison of 3 W170 protocols. Eur. J. Appl. Physiol.？1977, 37, 123–128.
[24]
Streiner, D.L. The case of the missing data: methods of dealing with dropouts and other research vagaries. Can. J. Psychiatry？2002, 47, 68–75.
[25]
Winzenberg, T.M.; Oldenburg, B.; Frendin, S.; De Wit, L.; Jones, G. A mother-based intervention trial for osteoporosis prevention in children. Prev. Med.？2006, 42, 21–26.
[26]
Cranney, A.; Wells, G.; Willan, A.; Griffith, L.; Zytaruk, N.; Robinson, V.; Black, D.; Adachi, J.; Shea, B.; Tugwell, P.; Guyatt, G. Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr. Rev.？2002, 23, 508–516, doi:10.1210/er.2001-2002. 12202465
[27]
Paganini-Hill, A.; Chao, A.; Ross, R.K.; Henderson, B.E. Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology？1991, 2, 16–25.
[28]
Heinonen, A.; Kannus, P.; Sievanen, H.; Oja, P.; Pasanen, M.; Rinne, M.; Uusi-Rasi, K.; Vuori, I. Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures. Lancet？1996, 348, 1343–1347.
[29]
McDermott, M.T.; Christensen, R.S.; Lattimer, J. The effects of region-specific resistance and aerobic exercises on bone mineral density in premenopausal women. Mil. Med.？2001, 166, 318–321.
[30]
Friedlander, A.L.; Genant, H.K.; Sadowsky, S.; Byl, N.N.; Gluer, C.C. A two-year program of aerobics and weight training enhances bone mineral density of young women. J. Bone Miner. Res.？1995, 10, 574–585.
[31]
Winzenberg, T.; Hansen, E.; Jones, G. How do women change osteoporosis-preventive behaviours in their children? Eur. J. Clin. Nutr.？2008, 62, 379–385, doi:10.1038/sj.ejcn.1602730. 17426746
[32]
Blalock, S.J.; Currey, S.S.; DeVellis, R.F.; DeVellis, B.M.; Giorgino, K.B.; Anderson, J.J.; Dooley, M.A.; Gold, D.T. Effects of educational materials concerning osteoporosis on women’s knowledge, beliefs, and behavior. Am. J. Health Promot.？2000, 14, 161–169. 10787768
