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The effects of bone mineral density testing on health related behaviours in a randomly selected population of Canadians Kingwell, Elaine

Abstract

Osteoporosis is a major health problem that can be mitigated by accurate prediction of future risk for bone fractures. Bone mineral density (BMD) testing can be conducted to assess people's risk of fracture, but its value rests on the ability to provide risk information effectively to those individuals who have low BMD; those individuals must then be willing to initiate and maintain recommended lifestyle behaviours and medications. This study assessed the influence of low BMD results and direct-to-participant feedback of results on awareness of diagnosis, information seeking about osteoporosis, bone-related medication use and health behaviours. Participants included 1,837 women and 869 men aged 40-60 years, from the population-based prospective Canadian Multicentre Osteoporosis Study, who had undergone baseline dual energy X-ray absorptiometry of the hip and spine. Bone-related health behaviour, medication use and risk factors for osteoporosis were measured by questionnaire at baseline and at 3-year follow-up; recall of BMD test results and subsequent information seeking were assessed at Year 3. The diagnosis reported to the participant and/or the family physician, was documented retrospectively by review of the feedback reports. Correct recall of osteoporosis or osteopenia diagnoses was poor, particularly in men. After adjustment for baseline health behaviour and other important covariates, low BMD results at baseline were associated with subsequent information seeking, and with higher calcium intake, Vitamin D supplement use and osteoporosis-related medication use at follow-up. A report of low BMD had no influence on exercise participation, smoking cessation, high alcohol consumption, or high caffeine intake. Direct-to-participant feedback v. feedback only to the physician was associated with increased awareness of diagnosis in those with a borderline or normal diagnosis, greater information seeking, and calcium supplementation in women and men, and increased exercise participation and reduced caffeine consumption in women. Educational strategies that specifically target men and specific interventions to support health behaviour change in those at increased risk of fracture are likely to be necessary if BMD testing in this age-group is to have a significant impact on fracture risk. Direct-to-participant feedback may offer an effective method of increasing awareness of BMD test results and influencing some health behaviours.

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