Table 3.

Meta-Analysis Results, Bone Mineral Density (BMD) Testing and/or Osteoporosis Treatment Outcome

Type of quality improvement strategy	Included studies	Summary estimate of relative risk (RR)a (95%CI; I2 valueb)	Summary estimate of risk difference (RD)a (95%CI; I2 valueb)
Meta-analysis findings for studies in which all patients had recent or prior fracture
Fracture liaison service/case managementc	Jaglal 2012,(39) Majumdar 2007,(46) Majumdar 2011(48)	2.05 (1.50–2.81; I2=36.3%)d	0.27 (0.06–0.48; I2=85.6%)e
Multifaceted intervention targeting providers and patients	Feldstein 2006,(36) Leslie 2012,(44) Olegario 2012(53)	2.44 (1.63–3.65; I2=84.3%)f	0.19 (0.09–0.29; I2=93.4%)f
Meta-analysis findings for studies that included patients without prior fracture
Multifaceted intervention targeting providers and patients	Solomon 2007,(60) Solomon 2007(61)	1.19 (0.83–1.71; I2=85.5%)	0.02 (−0.02–0.06; I2=86.4%)

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

^bPercentage of variation across studies attributable to heterogeneity

^cMeta-analysis results reported in this row for fracture liaison service/case management studies are for outcome of “appropriate management”, defined in included studies as BMD testing and treatment if bone mass low

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

^eSignificance of meta-analysis findings sensitive to removal of Majumdar et al. 2011 study⁽⁴⁸⁾ in influence/sensitivity analysis

^fSignificance of meta-analysis findings sensitive to removal of Leslie et al. study⁽⁴⁴⁾ in influence/sensitivity analysis