. Author manuscript; available in PMC: 2019 Sep 1.

Published in final edited form as: J Bone Miner Res. 2018 May 3;33(9):1585–1594. doi: 10.1002/jbmr.3437

Table 1.

Meta-Analysis Results, Bone Mineral Density (BMD)/Dual-Energy X-ray Absorptiometry (DXA) Testing Outcome

Type of quality improvement strategy	Included studies	Summary estimate of relative risk (RR)^a (95%CI; I² value^b)	Summary estimate of risk difference (RD)^a (95%CI; I² value^b)
Meta-analysis findings for studies in which all patients had recent or prior fracture
Fracture liaison service/case management	Majumdar 2007,⁽⁴⁶⁾ Majumdar 2011⁽⁴⁸⁾	2.11 (1.19–3.74; I²=78.9%)	0.43 (0.23–0.64; I²=57.2%)
Multifaceted intervention targeting providers and patients	Cranney 2008,⁽³²⁾ Feldstein 2006,⁽³⁶⁾ Leslie 2012,⁽⁴⁴⁾ Majumdar 2008,⁽⁴⁷⁾ Roux 2013^c(56)	3.05 (1.69–5.50; I²=92.9%)^d	0.24 (0.15–0.32; I²=86.1%)^d
Orthopedic surgeon or fracture clinic initiation of osteoporosis evaluation or management	Abou-Raya 2013,⁽²⁴⁾ Queally 2013,⁽⁵⁵⁾ Rozental 2008⁽⁵⁷⁾	2.26 (1.65–3.08; I²=0.0%)^d	0.44 (0.26–0.63; I²=53.4%)^d
Patient education and/or activation	Danila 2016,⁽³⁴⁾ Davis 2007,⁽³⁵⁾ Gardner 2005,⁽³⁷⁾ Kessous 2014,⁽⁴¹⁾ Merle 2017⁽⁵¹⁾	1.61 (1.07–2.43; I²=76.8%)^e	0.16 (0.06–0.26; I²=73.9%)^d
Meta-analysis findings for studies that included patients without prior fracture
Multifaceted intervention targeting providers and patients^f	Solomon 2007,⁽⁶⁰⁾ Solomon 2007⁽⁶¹⁾	1.17 (0.80–1.71; I²=82.7%)	0.02 (−0.02–0.06; I²=86.0%)
Patient education and/or activation^g	Heyworth 2014,⁽³⁸⁾ Solomon 2007⁽⁶¹⁾	1.11 (0.98–1.25; I²=0.0%)	0.01 (0.00–0.02; I²=0.0%)
Patient self-scheduling of DXA plus education	Warriner 2012,⁽⁶⁴⁾ Warriner 2014⁽⁶⁵⁾	3.36 (2.74–4.12; I²=61.6%)	0.13 (0.07–0.18; I²=95.1%)
Pharmacist initiation of screening	McConaha 2014,⁽⁴⁹⁾ Yuksel 2010⁽⁶⁶⁾	1.36 (0.52–3.58; I²=81.0%)	0.06 (−0.12–0.23; I²=57.8%)

Random-effects meta-analysis using DerSimonian and Laird method; results for intervention compared to comparator/control

Percentage of variation across studies attributable to heterogeneity

For Roux et al. study⁽⁵⁶⁾, results from both intervention groups combined were used for meta-analysis

Significance of meta-analysis findings robust to removal of individual studies in influence/sensitivity analysis

Significance of meta-analysis findings sensitive to removal of Gardner et al.⁽³⁷⁾, Kessous et al.⁽⁴¹⁾, or Merle et al.⁽⁵¹⁾ studies in influence/sensitivity analysis

Lafata et al. study⁽⁴³⁾ could not be included due to lack of clarity on 2×2 table values from reporting in paper. Contacted author but numbers were still unclear. However, if we assumed all randomized patients in Lafata et al. study⁽⁴³⁾ were included in osteoporosis screening analysis, meta-analysis results for RR and RD would still not be significant.