{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T17:44:22Z","timestamp":1774633462958,"version":"3.50.1"},"reference-count":75,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2018,1,26]],"date-time":"2018-01-26T00:00:00Z","timestamp":1516924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K23 AR062100"],"award-info":[{"award-number":["K23 AR062100"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["K12HS023009"],"award-info":[{"award-number":["K12HS023009"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,5,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>Osteoporosis treatment rates are declining, even among those with past fractures. Novel, low-cost approaches are needed to improve osteoporosis care. We conducted a parallel group, controlled, randomized clinical trial evaluating a behavioral intervention for improving osteoporosis medication use. A total of 2684 women with self-reported fracture history after age 45 years not using osteoporosis therapy from US Global Longitudinal Study of Osteoporosis in Women (GLOW) sites were randomized 1:1 to receive a multimodal, tailored, direct-to-patient, video intervention versus usual care. The primary study outcome was self-report of osteoporosis medication use at 6 months. Other outcomes included calcium and vitamin D supplementation, bone mineral density (BMD) testing, readiness for behavioral change, and barriers to treatment. In intent-to-treat analyses, there were no significant differences between groups (intervention versus control) in osteoporosis medication use (11.7% versus 11.4%, p\u2009=\u20090.8), calcium supplementation (31.8% versus 32.6%, p\u2009=\u20090.7), vitamin D intake (41.3% versus 41.9%, p\u2009=\u20090.8), or BMD testing (61.8% versus 57.1%, p\u2009=\u20090.2). In the intervention group, fewer women were in the precontemplative stage of behavior change, more women reported seeing their primary care provider, had concerns regarding osteonecrosis of the jaw, and difficulty in taking\/remembering to take osteoporosis medications. We found differences in BMD testing among the subgroup of women with no prior osteoporosis treatment, those who provided contact information, and those with no past BMD testing. In per protocol analyses, women with appreciable exposure to the online intervention (n\u2009=\u2009257) were more likely to start nonbisphosphonates (odds ratio [OR]\u2009=\u20092.70; 95% confidence interval [CI] 1.26\u20135.79) compared with the usual care group. Although our intervention did not increase the use of osteoporosis therapy at 6 months, it increased nonbisphosphonate medication use and BMD testing in select subgroups, shifted participants\u2019 readiness for behavior change, and altered perceptions of barriers to osteoporosis treatment. Achieving changes in osteoporosis care using patient activation approaches alone is challenging. \u00a9 2018 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.3395","type":"journal-article","created":{"date-parts":[[2018,1,26]],"date-time":"2018-01-26T16:37:52Z","timestamp":1516984672000},"page":"763-772","source":"Crossref","is-referenced-by-count":30,"title":["Evaluation of a Multimodal, Direct-to-Patient Educational Intervention Targeting Barriers to Osteoporosis Care: A Randomized Clinical Trial"],"prefix":"10.1093","volume":"33","author":[{"given":"Maria I","family":"Danila","sequence":"first","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan C","family":"Outman","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth J","family":"Rahn","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy S","family":"Mudano","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David T","family":"Redden","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroan J","family":"Allison","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical SchoolWorcesterMAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred A","family":"Anderson","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical SchoolWorcesterMAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"Wyman","sequence":"additional","affiliation":[{"name":"University of Massachusetts Medical SchoolWorcesterMAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan L","family":"Greenspan","sequence":"additional","affiliation":[{"name":"University of PittsburghPittsburghPAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea Z","family":"LaCroix","sequence":"additional","affiliation":[{"name":"University of California San DiegoLa JollaCAUSA"},{"name":"Group Health CooperativeSeattleWAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeri W","family":"Nieves","sequence":"additional","affiliation":[{"name":"Helen Hayes HospitalWest HaverstrawNYUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart L","family":"Silverman","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Medical CenterLos AngelesCAUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethel S","family":"Siris","sequence":"additional","affiliation":[{"name":"Columbia University Medical CenterNew YorkNYUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nelson B","family":"Watts","sequence":"additional","affiliation":[{"name":"Mercy Health Osteoporosis and Bone Health ServicesCincinnatiOHUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical SciencesIrma Lerma Rangel College of PharmacyTexas A&M UniversityCollege StationTXUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey R","family":"Curtis","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy H","family":"Warriner","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole C","family":"Wright","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth G","family":"Saag","sequence":"additional","affiliation":[{"name":"University of Alabama at BirminghamBirminghamALUSA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2018,1,26]]},"reference":[{"issue":"11","key":"2024021014343144300_jbmr3395-bib-0001","doi-asserted-by":"crossref","first-page":"4118","DOI":"10.1210\/jcem.85.11.6953","article-title":"Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. 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