Patient Activation After DXA Result Notification

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

Inclusion Criteria:

1. patients presenting for DXA

2. age 50 years of age or older

Exclusion Criteria:

1. non-English speakers

2. prisoners

3. people who have mental disabilities

4. individuals younger than age 50 years

5. individuals who do not have access to a telephone

6. deaf patients