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 = 0.8),
calcium supplementation (31.8% versus 32.6%, p = 0.7),
vitamin D intake (41.3% versus 41.9%, p = 0.8), or BMD testing (61.8% versus 57.1%, p = 0.2). 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 = 257) were more likely to start nonbisphosphonates (odds ratio [OR] = 2.70; 95% confidence interval [CI] 1.26-5.79) 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' readiness for behavior change, and altered perceptions of barriers to
osteoporosis treatment. Achieving changes in
osteoporosis care using patient activation approaches alone is challenging. © 2018 American Society for Bone and
Mineral Research.