Improving Quality of Osteoporosis Care Through Patient Storytelling


The purpose of this exploratory study is to test novel, mailed, low-cost, direct-to-patient intervention materials (i.e., a personalized letter and osteoporosis information pamphlet) designed to increase rates of dual energy X-ray absorptiometry (DXA) utilization and improve osteoporosis quality of care.

Full Title of Study: “Randomized Trial of a Mailed Intervention and Self-Scheduling to Improve Osteoporosis Screening in Postmenopausal Women”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Diagnostic
    • Masking: Single (Participant)
  • Study Primary Completion Date: December 2010

Detailed Description

While the occurrence of a fragility fracture (e.g. hip fracture) is indicative of low BMD and a clinical diagnosis of osteoporosis made, osteoporosis can be identified in asymptomatic patients using dual energy x-ray absorptiometry (DXA). United States (U.S.) guidelines recommend screening bone density tests using central DXA in all women 65 years or older. However, fewer than one-third of eligible U.S. women age 65 and older undergo DXA testing. The main barrier to achieving greater rates of osteoporosis screening is identifying a systematic, effective, and generalizable way for healthcare providers and patients to schedule DXA results. Given that national guidelines recommend DXA screening for all older women, the reasons a majority of women do not receive DXA testing are likely multifactorial. Patients and their health care providers may be unaware of preventative screening recommendations and the reasons for these recommendations. Screening tests that are required relatively infrequently (i.e. less than once a year) may be difficult for patients and physicians to remember if there are few triggers (e.g. seasonality as a trigger to motivate influenza vaccination). Additionally, primary care providers (PCPs) are responsible for managing a large number of comorbidities and acute care needs and may be unable to stay current with all preventative care needs during increasingly short clinic visits.


  • Behavioral: Patient Pamphlet
    • letter informs patient of opportunity to self-schedule a DXA scan; pamphlet includes information about receiving a DXA scan

Arms, Groups and Cohorts

  • Experimental: Educational Pamphlet and letter
    • Letter invites patient to self-schedule a DXA; educational pamphlet includes information about DXA scans

Clinical Trial Outcome Measures

Primary Measures

  • DXA scheduled
    • Time Frame: 6 months
    • Patient scheduled a DXA within 6 months of receiving intervention materials

Participating in This Clinical Trial

Inclusion Criteria

  • Female – Age 65 or older – At least one visit with a primary care physician in the previous 12 months Exclusion Criteria:

  • DXA scan in the previous 5 years

Gender Eligibility: Female

Minimum Age: 65 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Alabama at Birmingham
  • Collaborator
    • Procter and Gamble
  • Provider of Information About this Clinical Study
    • Jeffrey R. Curtis, MD MPH, UAB
  • Overall Official(s)
    • Jeffrey R Curtis, MD, MPH, MS, Principal Investigator, University of Alabama at Birmingham

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