A randomized trial of a mailed intervention and self-scheduling to improve osteoporosis screening in postmenopausal women

J Bone Miner Res. 2012 Dec;27(12):2603-10. doi: 10.1002/jbmr.1720.


Guidelines recommend bone density screening with dual-energy X-ray absorptiometry (DXA) in women 65 years or older, but <30% of eligible women undergo DXA testing. There is a need to identify a systematic, effective, and generalizable way to improve osteoporosis screening. A group randomized, controlled trial of women ≥65 years old with no DXA in the past 4 years, randomized to receive intervention materials (patient osteoporosis brochure and a letter explaining how to self-schedule a DXA scan) versus usual care (control) was undertaken. Outcome of interest was DXA completion. Of 2997 women meeting inclusion criteria, 977 were randomized to the intervention group. A total of 17.3% of women in the intervention group completed a DXA, compared to 5.2% in the control group (12.1% difference, p < 0.0001). When including only those medically appropriate, we found a difference of 19% between the two groups (p < 0.0001). DXA receipt was greater in main clinic patients compared to satellite clinic patients (20.9% main clinic versus 10.1% satellite clinic). The cost to print and mail the intervention was $0.79 per patient, per mailing. The number of women to whom intervention needed to be mailed to yield one extra DXA performed was 9, at a cost of $7.11. DXA scan completion was significantly improved through use of a mailed osteoporosis brochure and the availability for patients to self-schedule. This simple approach may be an effective component of a multifaceted quality improvement program to increase rates of osteoporosis screening.

Trial registration: ClinicalTrials.gov NCT01112098.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / statistics & numerical data*
  • Academic Medical Centers
  • Aged
  • Aged, 80 and over
  • Alabama
  • Appointments and Schedules*
  • Female
  • Humans
  • Mass Screening*
  • Osteoporosis, Postmenopausal / diagnostic imaging*
  • Patient Education as Topic / methods*
  • Postal Service*

Associated data

  • ClinicalTrials.gov/NCT01112098