Implementation research in osteoporosis: an update.
OBJECTIVE
To provide an update of recent and influential studies of implementation research in osteoporosis.


RESULTS
In recent years, several implementation interventions have been designed and tested to improve osteoporosis screening (primary prevention), increase bone mineral density testing and treatment after a fracture (secondary prevention), and enhance shared decision-making along with long-term medication adherence and persistence. Different forms of care coordination, from multifaceted interventions through labor-intensive and capital-intensive 'fracture liaison services', seem most consistently to improve quality of osteoporosis care. When randomized trials (rather than observational studies) are used to test these various interventions, they are often found to be ineffective, and even when they are effective, the effect sizes are modest and less than had been anticipated by researchers or required by decision-makers. However, even modest effects have been shown in economic analyses to be very cost-effective or cost-saving.


CONCLUSIONS
Although osteoporosis implementation research has tended to lag behind other conditions such as coronary disease or diabetes, in recent years, the number, quality, novelty, and rigor of osteoporosis intervention trials have substantially increased - though much more work remains to be done.
Department of Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Sumit R
SR
Majumdar
D015519:Bone Density; D003362:Cost-Benefit Analysis; D050723:Fractures, Bone / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics