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Individualized Fracture Risk Feedback and Long-term Benefits After 10 Years

Published:December 12, 2017DOI:https://doi.org/10.1016/j.amepre.2017.10.018

      Introduction

      This study aimed to determine if beneficial effects of individualized feedback of fracture risk on osteoporosis preventive behaviors and bone mineral density observed in a 2-year trial were sustained long-term.

      Methods

      This was a 10-year follow-up of a 2-year RCT in 470 premenopausal women aged 25–44 years, who were randomized to one of two educational interventions (the Osteoporosis Prevention and Self-Management Course [OPSMC] or an osteoporosis information leaflet) and received tailored feedback of their relative risk of fracture in later life (high versus normal risk groups). Bone mineral density of lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical activity, dietary calcium intake, calcium and vitamin D supplements, and smoking status were measured by questionnaires.

      Results

      From 2 to 12 years, the high-risk group had a smaller decrease in femoral neck bone mineral density (β=0.023, 95% CI=0.005, 0.041 g/cm2) but similar lumbar spine bone mineral density change as the normal-risk group. They were more likely to use calcium (relative risk=1.66, 95% CI=1.22, 2.24) and vitamin D supplements (1.99, 95% CI=1.27, 3.11). The OPSMC had no effects on bone mineral density change. Both high-risk (versus normal-risk) and the OPSMC groups (versus leaflet) had a more favorable pattern of smoking behavior change (relative risk=1.85, 95% CI=0.70, 4.89 and relative risk=2.27, 95% CI=0.86, 6.01 for smoking cessation; relative risk=0.33, 95% CI=0.13, 0.80 and relative risk=0.28, 95% CI=0.10, 0.79 for commenced or persistent smoking).

      Conclusions

      Feedback of high fracture risk to younger women was associated with long-term improvements in osteoporosis preventive behaviors and attenuated femoral neck bone mineral density loss. Therefore, this could be considered as a strategy to prevent osteoporosis.

      Trial registration

      Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260.
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      References

        • Bauer U.E.
        • Briss P.A.
        • Goodman R.A.
        • Bowman B.A.
        Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA.
        Lancet. 2014; 384: 45-52https://doi.org/10.1016/S0140-6736(14)60648-6
        • Edwards A.G.
        • Naik G.
        • Ahmed H.
        • et al.
        Personalised risk communication for informed decision making about taking screening tests.
        Cochrane Database Syst Rev. 2013; 2: CD001865https://doi.org/10.1002/14651858.CD001865.pub3
        • Han P.K.
        • Hootsmans N.
        • Neilson M.
        • et al.
        The value of personalised risk information: a qualitative study of the perceptions of patients with prostate cancer.
        BMJ Open. 2013; 3: e003226https://doi.org/10.1136/bmjopen-2013-003226
        • Edwards A.
        • Hood K.
        • Matthews E.
        • et al.
        The effectiveness of one-to-one risk communication interventions in health care: a systematic review.
        Med Decis Making. 2000; 20: 290-297https://doi.org/10.1177/0272989X0002000305
        • Soler R.E.
        • Leeks K.D.
        • Razi S.
        • et al.
        A systematic review of selected interventions for worksite health promotion. The assessment of health risks with feedback.
        Am J Prev Med. 2010; 38: S237-S262https://doi.org/10.1016/j.amepre.2009.10.030
        • Cummings S.R.
        • Melton L.J.
        Epidemiology and outcomes of osteoporotic fractures.
        Lancet. 2002; 359: 1761-1767https://doi.org/10.1016/S0140-6736(02)08657-9
        • 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: 12https://doi.org/10.1186/1471-2458-6-12
        • 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: 109-115https://doi.org/10.1385/JCD:2:2:109
        • 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: 2143-2149https://doi.org/10.1359/jbmr.1999.14.12.2143
        • Nguyen T.
        • Sambrook P.
        • Kelly P.
        • et al.
        Prediction of osteoporotic fractures by postural instability and bone density.
        BMJ. 1993; 307: 1111-1115https://doi.org/10.1136/bmj.307.6912.1111
        • 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
        • English R.
        • Lewis J.
        Nutritional Values of Australian Foods.
        Australian Government Publishing Service, Canberra1991
        • 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: 191-201https://doi.org/10.1093/oxfordjournals.aje.a117618
        • 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: 1628-1633https://doi.org/10.1359/jbmr.1999.14.9.1628
      1. Chakraborty H, Gu H. A mixed model approach for intent-to-treat analysis in longitudinal clinical trials with missing values. RTI Press Publication No. MR-0009-0903. Research Triangle Park, NC: RTI Press. 〈doi:10.3768/rtipress.2009.mr.0009.0903〉.

        • McNutt L.A.
        • Wu C.
        • Xue X.
        • Hafner J.P.
        Estimating the relative risk in cohort studies and clinical trials of common outcomes.
        Am J Epidemiol. 2003; 157: 940-943https://doi.org/10.1093/aje/kwg074
        • Little R.J.
        • D’Agostino R.
        • Cohen M.L.
        • et al.
        The prevention and treatment of missing data in clinical trials.
        N Engl J Med. 2012; 367: 1355-1360https://doi.org/10.1056/NEJMsr1203730
        • Vansteelandt S.
        • Carpenter J.
        • Kenward M.G.
        Analysis of incomplete data using inverse probability weighting and doubly robust estimators.
        Methodology (Gott). 2010; 6: 37-48https://doi.org/10.1027/1614-2241/a000005
        • Usher-Smith J.A.
        • Silarova B.
        • Schuit E.
        • Moons K.G.
        • Griffin S.J.
        Impact of provision of cardiovascular disease risk estimates to healthcare professionals and patients: a systematic review.
        BMJ Open. 2015; 5: e008717https://doi.org/10.1136/bmjopen-2015-008717
        • Persell S.D.
        • Brown T.
        • Lee J.Y.
        • et al.
        Individualized risk communication and outreach for primary cardiovascular disease prevention in community health centers: randomized trial.
        Circ Cardiovasc Qual Outcomes. 2015; 8: 560-566https://doi.org/10.1161/CIRCOUTCOMES.115.001723
        • Rimes K.A.
        • Salkovskis P.M.
        • Shipman A.J.
        Psychological and behavioural effects of bone density screening for osteoporosis.
        Psychol Health. 1999; 14: 585-608https://doi.org/10.1080/08870449908410752
        • Nguyen T.V.
        • Center J.R.
        • Eisman J.A.
        Femoral neck bone loss predicts fracture risk independent of baseline BMD.
        J Bone Miner Res. 2005; 20: 1195-1201https://doi.org/10.1359/JBMR.050215
        • Hartmann-Boyce J.
        • Lancaster T.
        • Stead L.F.
        Print-based self-help interventions for smoking cessation.
        Cochrane Database Syst Rev. 2014; 6: CD001118https://doi.org/10.1002/14651858.CD001118.pub3
        • Stead L.F.
        • Hartmann-Boyce J.
        • Perera R.
        • Lancaster T.
        Telephone counselling for smoking cessation.
        Cochrane Database Syst Rev. 2013; 8: CD002850https://doi.org/10.1002/14651858.CD002850.pub3
        • Croll J.
        • Norton C.J.
        • Gray L.C.
        • Bryett A.
        • Smith A.C.
        Telehealth opportunities in regional Queensland: a scoping study.
        J Telemed Telecare. 2012; 18: 451-454https://doi.org/10.1258/jtt.2012.gth106
        • Hilger J.
        • Friedel A.
        • Herr R.
        • et al.
        A systematic review of vitamin D status in populations worldwide.
        Br J Nutr. 2014; 111: 23-45https://doi.org/10.1017/S0007114513001840
        • Rosen C.J.
        • Adams J.S.
        • Bikle D.D.
        • et al.
        The nonskeletal effects of vitamin D: an Endocrine Society scientific statement.
        Endocr Rev. 2012; 33: 456-492https://doi.org/10.1210/er.2012-1000
        • Winters-Stone K.M.
        • Snow C.M.
        Site-specific response of bone to exercise in premenopausal women.
        Bone. 2006; 39: 1203-1209https://doi.org/10.1016/j.bone.2006.06.005
        • Martyn-St James M.
        • Carroll S.
        Effects of different impact exercise modalities on bone mineral density in premenopausal women: a meta-analysis.
        J Bone Miner Metab. 2010; 28: 251-267https://doi.org/10.1007/s00774-009-0139-6
        • Bassey E.J.
        • Ramsdale S.J.
        Increase in femoral bone density in young women following high-impact exercise.
        Osteoporos Int. 1994; 4: 72-75https://doi.org/10.1007/BF01623226
        • Winzenberg T.
        • Jones G.
        Cost-effectiveness of nutritional interventions for bone health in children and young adults – what is known and where are the gaps?.
        in: Gerald J.K. Watson R.R. Preedy V.R. Nutrients, Dietary Supplements, and Nutriceuticals. Humana Press, 2011: 121-141
        • Kroon F.P.
        • van der Burg L.R.
        • Buchbinder R.
        • Osborne R.H.
        • Johnston R.V.
        • Pitt V.
        Self-management education programmes for osteoarthritis.
        Cochrane Database Syst Rev. 2014; 1: CD008963https://doi.org/10.1002/14651858.CD008963.pub2
      2. Foster G, Taylor SJ, Eldridge SE, Ramsay J, Griffiths CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database Syst Rev. 2007(4):CD005108. https://doi.org/10.1002/14651858.CD005108.pub2.

        • 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: 95-103https://doi.org/10.1385/JCD:8:1:095
        • Wu F.
        • Laslett L.L.
        • Wills K.
        • Oldenburg B.
        • Jones G.
        • Winzenberg T.
        Effects of individualized bone density feedback and educational interventions on osteoporosis knowledge and self-efficacy: a 12-yr prospective study.
        J Clin Densitom. 2014; 17: 466-472https://doi.org/10.1016/j.jocd.2014.07.008
        • Vartiainen E.
        • Seppala T.
        • Lillsunde P.
        • Puska P.
        Validation of self reported smoking by serum cotinine measurement in a community-based study.
        J Epidemiol Community Health. 2002; 56: 167-170https://doi.org/10.1136/jech.56.3.167
        • Patrick D.L.
        • Cheadle A.
        • Thompson D.C.
        • Diehr P.
        • Koepsell T.
        • Kinne S.
        The validity of self-reported smoking: a review and meta-analysis.
        Am J Public Health. 1994; 84: 1086-1093https://doi.org/10.2105/AJPH.84.7.1086