title: Patient education in osteoporosis prevention: a systematic review focusing on methodological quality of randomised controlled trials.
abstract: This review summarizes evidence regarding the effects of patient education in osteoporosis prevention and treatment. The included studies reveal mixed results on a variety of endpoints. Methodological improvem ent of future RCTs (e.g. with regard to randomization and duration of follow-up) might yield more conclusive evidence on the effects of patient education in osteoporosis INTRODUCTION: This review aims to evaluate the effects of patient education on osteoporosis prevention and treatment results.
  
  
  
  Multiple databases including PubMed and Embase were searched until February 2016. Randomised controlled trials (RCTs) were eligible if they included adults diagnosed with or at risk of osteoporosis and assessed patient education interventions (group- or individual-based). Outcomes regarding osteoporosis management including initiation of and adherence to pharmacological therapy, physical activity, calcium and vitamin D intake, changes in smoking behaviour, fractures, quality of life (QoL) and osteoporosis knowledge were evaluated. The Cochrane collaboration's tool for assessing the risk of bias was used to assess the internal validity of included trials.
  
  
  
  Fifteen articles (13 different studies) published between 2001 and 2013 were included (group-based education = 7, individual-based education = 5, both = 1). The general risk of bias was considered as moderate to high. The effects on 'bone mineral density (BMD) testing and/or pharmacological therapy' (composite endpoint), 'calcium intake' and 'vitamin D intake' as well as 'osteoporosis knowledge' were statistically significant in favour of the intervention in ≥50% of the studies analysing these outcomes. Differences between the intervention and the control group regarding 'pharmacological therapy', 'medication adherence', 'physical activity', 'fractures' and 'QoL' were found to be statistically significant in <50% of the trials.
  
  
  
  This review indicates that it is still unclear whether patient education is beneficial and whether it has a significant and clinically relevant impact on osteoporosis management results. Educational programmes for osteoporosis require further investigation within the context of well-conducted RCTs.
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
authors.forename: Jana-Carina
authors.initials: JC
authors.lastname: Morfeld
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Vennedey
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany. dirk.mueller@uk-koeln.de.
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.affiliation: Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany.
authors.forename: Dawid
authors.initials: D
authors.lastname: Pieper
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Straße 176-178, 50935, Cologne, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D055118:Medication Adherence; D010024:Osteoporosis / Q000517:prevention & control*; D058866:Osteoporotic Fractures / Q000517:prevention & control; D010353:Patient Education as Topic / Q000379:methods*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards
chemical_list: D050071:Bone Density Conservation Agents
keywords: Intervention; Osteoporosis; Patient education; Prevention; Systematic review; Treatment