ORIGINAL ARTICLE Comparison of interactive voice response, patient mailing, and mailed registry to encourage screening for osteoporosis: a randomized controlled trial L. Heyworth & K. Kleinman & S. Oddleifson & L. Bernstein & J. Frampton & M. Lehrer & K. Salvato & T. W. Weiss & S. R. Simon & M. Connelly Received: 12 September 2013 /Accepted: 24 January 2014 # International Osteoporosis Foundation and National Osteoporosis Foundation 2014 Abstract Summary Guidelines recommend screening for osteoporosis with bone mineral density (BMD) testing in menopausal women, particularly those with additional risk factors for fracture. Many eligible women remain unscreened. This ran- domized study demonstrates that a single outreach interactive voice response phone call improves rates of BMD screening among high-risk women age 50–64. Introduction Osteoporotic fractures are a major cause of dis- ability and mortality. Guidelines recommend screening with BMD for menopausal women, particularly those with additional risk factors for fracture. However, many women remain unscreened. We examined whether telephonic interac- tive voice response (IVR) or patient mailing could increase rates of BMD testing in high risk, menopausal women. Methods We studied 4,685 women age 50–64 years within a not-for-profit health plan in the United States. All women had risk factors for developing osteoporosis and no prior BMD testing or treatment for osteoporosis. Patients were randomly allocated to usual care, usual care plus IVR, or usual care plus mailed educational materials. To avoid contamination, patients within a single primary care physician practice were random- ized to receive the same intervention. The primary endpoint was BMD testing at 12 months. Secondary outcomes included BMD testing at 6 months and medication use at 12 months. Results Mean age was 57 years. Baseline demographic and clinical characteristics were similar across the three study groups. In adjusted analyses, the incidence of BMD screening was 24.6 % in the IVR group compared with 18.6 % in the usual care group (P<0.001). There was no difference between the patient mailing group and the usual care group ( P=0.3). Conclusions In this large community-based randomized trial of high risk, menopausal women age 50–64, IVR, but not patient mailing, improved rates of BMD screening. IVR re- mains a viable strategy to incorporate in population screening interventions. Keywords Bone mineral density . Interactive voice response . Mailed registry . Osteoporosis screening . Patient mailing Introduction Osteoporotic fractures are a significant cause of disability and mortality. Approximately 10 million Americans have osteo- porosis, and an estimated 34 million have low bone mineral Dr. Simon and Dr. Connelly contributed equally to the role of senior author of this manuscript. Clinicaltrials.gov registration number NCT00145080. L. Heyworth : S. R. Simon Brigham and Women’ s Hospital, Boston, MA, USA K. Kleinman : M. Connelly Harvard Pilgrim Health Care Institute at Harvard Medical School, Boston, MA, USA S. Oddleifson : L. Bernstein : J. Frampton : M. Lehrer : K. Salvato Harvard Pilgrim Health Care Institute, Wellesley, MA, USA T. W. Weiss Merck, West Point, PA, USA L. Heyworth : S. R. Simon Veterans Affairs Boston Healthcare System, Boston, MA, USA K. Kleinman Harvard Medical School, Boston, MA, USA L. Heyworth (*) Section of General Internal Medicine, VA Boston Healthcare System, 150 S. Huntington Avenue, Mailstop 152G, Jamaica Plain, MA 02130, USA e-mail: lheyworth@gmail.com Osteoporos Int DOI 10.1007/s00198-014-2629-1