Objective : To evaluate extent to which preventive procedures against osteoporosis performed by Japanese municipalities are based on evidence, and to clarify factors associated with preventive procedures based on firm evidence.
Methods : A questionnaire survey by mail was performed for 1,978 municipal health centers throughout Japan. The major survey items were the characteristics of the planning process of preventive procedures, the specialists who were involved, reference materials, subjects and methods for screening osteoporosis, and subjects and contents of health education. Logistic regression analysis was performed to quantify the effect of characteristics in planning process of preventive procedures in eventually conducting a highly evidence-based procedure.
Results : The measurement method was quantitative ultrasound in approximately 40% and dual X-ray absorptiometry in the lumbar spine or proximal femer in 5%. Instruction regarding a “dietary calcium intake≥800 mg/day” was given by 3%, “do not smoke” by 25%, and “activation of daily life” for elderly females by 15%, all of which have high level of evidence. Participation of nurses in the planning process and performance of bone density measurement without outsourcing increased the probability of institutions which targeted all females aged≥65 years for screening. Planning using instruction manuals produced by some prefectures or certain commercially available osteoporosis prevention manuals decreased its probability. Factors that increased the probability of institutions providing evidence-based health education were the participation of nutritionists or physiotherapists in the planning process, use of appropriate reference materials and conducting the education in municiparity's own health centers.
Conclusion : Evidence-based procedures were performed frequently in various items but not in others. Some factors relating to conducting evidence-based practices were clarified, and could be used to improve planning process for the preventive procedures for osteoporosis in municiparities.
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