Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age

Recommendations

Education and psychosocial support

Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of a
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  1. Summary of recommendations
  3. Figures and tables
  4. Appendix A. Process report
  5. Appendix B. Working group
  6. Provided under licence

Evidence statement

International guidelines recommend educational interventions for patients following a fragility fracture in order to increase the likelihood of adoption of bone-protective behaviours and to improve adherence to medication.1,2 High-quality trial or observational evidence concerning the value of education and psychosocial support for osteoporosis is lacking, particularly in the area of primary prevention. A systematic review of 13 cross-sectional studies investigating men’s knowledge of osteoporosis found that men know very little about the disease, its risk factors, or prevention.3 Educational interventions were found to increase initiation of calcium supplementation and knowledge about osteoporosis prevention in this group. A two-year Australian randomised controlled trial of 470 healthy women aged 25–44 years found that individualised feedback on bone mineral density (BMD), combined with minimal education via leaflet or small groups is effective at increasing hip but not spine BMD in premenopausal women.4 Although any long-term benefits could not be ascertained by this study, the authors noted the potential for behavioural change in other disease risk areas using this approach.

Specific osteoporosis self-management programs are conducted by public hospital health-promotion units and community health centres. It is the consensus of the Working Group that general practitioners have an important role in delivering patient education, psychosocial support and referral to support groups where needed.

Grade: D – consensus

Recommendation 9
Provide postmenopausal women and men over 50 years of age at risk of or diagnosed with osteoporosis, access to education, psychosocial support and encouragement to seek support from appropriate sources according to individual needs.

Those at risk of developing osteoporosis may require access to education about disease prevention and strategies to encourage reduction in disease risk. Patients who have been diagnosed with osteoporosis may require ongoing education to improve medication adherence, as well as assistance with selfmanagement strategies and psychosocial support. A range of support agencies offer education material, programs and counselling. Self-management programs usually focus on:

  • education and awareness about the disease process
  • promotion of a healthy lifestyle
  • prevention of further fractures
  • management and rehabilitation techniques
  • pain management
  • falls prevention techniques
  • psychosocial welfare (dealing with depression, social isolation, fear of falling).
  1. Scottish Intercollegiate Guidelines Network. Management of osteoporosis and the prevention of fragility fractures. Edinburgh: SIGN; 2015.
  2. Papaioannou A, Morin S, Cheung AM, et al. 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. CMAJ 2010;182(17):1864–73.
  3. Gaines JM, Marx KA. Older men’s knowledge about osteoporosis and educational interventions to increase osteoporosis knowledge in older men: A systematic review. Maturitas 2011;68(1):5–12.
  4. Winzenberg T, Oldenburg B, Frendin S, De Wit L, Riley M, Jones G. The effect on behavior and bone mineral density of individualized bone mineral density feedback and educational interventions in premenopausal women: A randomized controlled trial. BMC Public Health 2006,6:12. doi:10.1186/1471-2458-6-12.
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