Our findings from 55 RCTs and 18 sub-group meta-analyses showed that complex implementation interventions with multiple components consisting of at least education + feedback + follow-up significantly increased the initiation of osteoporosis medications , and interventions with at least education + follow-up significantly increased the initiation of osteoporosis investigations .
No significant impact was found for any type of intervention to reduce fracture .
Complex interventions that include at least education + follow-up or feedback have the most potential for increasing osteoporosis investigations and treatment .
Patient education appears to be an important component in osteoporosis disease management
Osteoporosis is affecting over 200 million people worldwide .
Despite available guidelines , care for these patients remains sub-optimal .
We developed an osteoporosis tool to address the multiple dimensions of chronic disease management .
Findings from its evaluation showed a significant increase from baseline in osteoporosis investigations and treatment , so we are revising this tool to include multiple chronic conditions including an up date of evidence about osteoporosis .
Our objectives were to conduct a systematic review of osteoporosis interventions in adults at risk for osteoporosis .
GRADE guidelines: 3. Rating the quality of evidence.
This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence
Our findings from 55 RCTs and 18 sub-group meta-analyses showed that complex implementation interventions with multiple components consisting of at least education + feedback + follow-up significantly increased the initiation of osteoporosis medications , and interventions with at least education + follow-up significantly increased the initiation of osteoporosis investigations .
No significant impact was found for any type of intervention to reduce fracture .
Complex interventions that include at least education + follow-up or feedback have the most potential for increasing osteoporosis investigations and treatment .
Patient education appears to be an important component in osteoporosis disease management
Osteoporosis is affecting over 200 million people worldwide .
Despite available guidelines , care for these patients remains sub-optimal .
We developed an osteoporosis tool to address the multiple dimensions of chronic disease management .
Findings from its evaluation showed a significant increase from baseline in osteoporosis investigations and treatment , so we are revising this tool to include multiple chronic conditions including an up date of evidence about osteoporosis .
Our objectives were to conduct a systematic review of osteoporosis interventions in adults at risk for osteoporosis .