Archives of Osteoporosis

, 13:4 | Cite as

Diet and exercise changes following bone densitometry in the Patient Activation After DXA Result Notification (PAADRN) study

  • Douglas W. RoblinEmail author
  • Peter Cram
  • Yiyue Lou
  • Stephanie W. Edmonds
  • Sylvie F. Hall
  • Michael P. Jones
  • Kenneth G. Saag
  • Nicole C. Wright
  • Fredric D. Wolinsky
  • on behalf of the PAADRN Investigators
Original Article



Calcium and vitamin D intake and exercise are suboptimal among older adults. Following bone densitometry, a letter communicating individualized fracture risk accompanied by an educational brochure improved participants’ lifestyle—but no more than existing communication strategies—over 52 weeks. Simple communication strategies are insufficient for achieving optimal levels of bone health behaviors.


The Patient Activation After DXA Result Notification (PAADRN) study was designed to evaluate whether a letter with individualized fracture risk and an educational brochure mailed to patients soon after their DXA might improve bone health behaviors (daily calcium intake, vitamin D supplementation, and weekly exercise sessions) compared to slower, less individualized communication characterizing usual care.


Participants ≥ 50 years were recruited, at three sites, following their DXA and randomized with 1:1 allocation to intervention and control (usual care only) groups. Data were collected at enrollment interview and by phone survey at 12 and 52 weeks thereafter. Intention-to-treat analyses were conducted on 7749 of the 20,397 eligible participants who enrolled. Changes in bone health behaviors were compared within and between study groups. Average treatment effects and heterogeneity of treatment effects were estimated with multivariable linear and logistic regression models.


In unadjusted analyses, calcium intake, vitamin D supplementation, and weekly exercise sessions increased significantly over 52 weeks within both the intervention and control groups (all p < 0.001). In unadjusted analyses and multivariable models, increases in each behavior did not significantly differ between the intervention and control groups. Intervention group participants with a > 20% 10-year fracture risk at enrollment did, however, have a significantly greater increase in calcium intake compared to other study participants (p = 0.031).


Bone health behaviors improved, on average, over 52 weeks among all participants following a DXA. Receipt of the PAADRN letter and educational brochure did not directly improve bone health behaviors compared to usual care.

Trial registration

The Patient Activation after DXA Result Notification (PAADRN) Study is registered at ClinicalTrials.Gov: NCT01507662,


Osteoporosis Fracture risk Diet Exercise Patient-provider communication 



We thank Rebecca Burmeister, MPH (UI); Mollie Giller, MPH (UI); April Miller RT (UI), CBDT; Amna Rizvi-Toner, BA, BS (UI); Kara Wessels, BA (UI); Brandi Robinson (KP); Akeba Mitchell (KP); Aimee Khamar (KP); and Roslin Nelson (KP) and all of the staff at the Iowa Social Science Research Center for recruiting and interviewing all study participants. All except Ms. Miller were compensated from grant funds for their time. We also thank Ryan Outman, MS (UAB), for coordinating and facilitating the recruitment of study participants. We also thank Thuy Nguyen, MS (UI), for managing the trial data. Finally, we thank the 7749 patients who participated in PAADRN.

Funding information

This work was supported by R01 AG033035 to Dr. Cram and Dr. Wolinsky from the NIA at the NIH. Dr. Cram is also supported by a K24 AR062133 award from the NIAMS at the NIH.

Compliance with ethical standards

Conflicts of interest

F. D. Wolinsky, Y. Lou, S. W. Edmonds, S. F. Hall, M. P. Jones, P. Cram, and D. W. Roblin have no conflicts of interest. N. C. Wright has received unrestricted grant support from Amgen for work unrelated to this project. K. G. Saag has received grants from Amgen, Eli Lilly, and Merck and has served as a paid consultant to Amgen, Eli Lilly, and Merck unrelated to this project. The NIA, NIAMS, and NIH had no role in the (a) design and conduct of the study; (b) collection, management, analysis, and interpretation of the data; (c) preparation, review, or approval of the manuscript; or (d) decision to submit the manuscript for publication.

Supplementary material

11657_2017_402_MOESM1_ESM.docx (31 kb)
Table S1 (DOCX 30 kb).
11657_2017_402_MOESM2_ESM.docx (29 kb)
Table S2 (DOCX 28 kb).
11657_2017_402_MOESM3_ESM.docx (30 kb)
Table S3 (DOCX 29 kb).
11657_2017_402_MOESM4_ESM.docx (32 kb)
Table S4 (DOCX 32 kb).


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • Douglas W. Roblin
    • 1
    • 2
    Email author
  • Peter Cram
    • 3
    • 4
    • 5
  • Yiyue Lou
    • 6
  • Stephanie W. Edmonds
    • 3
    • 7
  • Sylvie F. Hall
    • 7
  • Michael P. Jones
    • 6
  • Kenneth G. Saag
    • 8
  • Nicole C. Wright
    • 8
    • 9
  • Fredric D. Wolinsky
    • 3
    • 7
    • 10
  • on behalf of the PAADRN Investigators
  1. 1.Mid-Atlantic Permanente Research InstituteRockvilleUSA
  2. 2.Center for Clinical and Outcomes Research, Kaiser PermanenteAtlantaUSA
  3. 3.Division of General Internal Medicine, Department of Internal MedicineUniversity of Iowa Carver College of MedicineIowa CityUSA
  4. 4.Faculty of MedicineUniversity of TorontoTorontoCanada
  5. 5.Division of General Internal Medicine and GeriatricsMt. Sinai/UHN HospitalsTorontoCanada
  6. 6.Department of BiostatisticsUniversity of Iowa College of Public HealthIowa CityUSA
  7. 7.College of NursingUniversity of IowaIowa CityUSA
  8. 8.Division of Clinical Immunology and Rheumatology, Department of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  9. 9.Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamUSA
  10. 10.Department of Health Management and Policy, College of Public HealthUniversity of IowaIowa CityUSA

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