Table 4 Key question 4 (acceptability of screening and/or treatment) study eligibility criteria

Population

 ■ Adults aged ≥ 40 years (we will include studies where ≥ 80% of the sample or the sample mean age − 1 standard deviation is ≥ 40 years)

 ■ Population subgroups include: absolute fracture risk (perceived or actual; may use other risk factors as proxy: age, sex, menopausal status, BMD); prior screening, history of fracture, prior use of anti-osteoporotic medication; prior diagnosis of osteoporosis; level of concern about fractures or perceived severity of fractures

 ■ Adults < 40 years

 ■ Current use of anti-osteoporosis drugs (> 10% of population), although study participants may have recently received a prescription or recommendation to start treatment.

 ■ Studies with > 50% population with a prior fragility fracture, or secondary causes of osteoporosis (e.g., endocrine disorders, chronic glucocorticoid medications, etc.); unless study provides data for participants without these conditions

Exposure/intervention

 ■ Population may or may not have knowledge of their own medical fracture risk/BMD but must have at least some general scenario or background information (e.g., scenarios, vignettes, educational material, decision aid) containing the possible magnitude of benefits and/or harms from screening* or treatment** for fragility fractures or osteoporosis, or

 ■ Investigators solicit the magnitude of benefits and/or harms where screening or treatment is acceptable.

*Context of screening should involve use of absolute risk assessment tools and/or dual-energy x-ray absorptiometry (DXA) with or without vertebral fracture assessment (VFA) or spinal X-ray

**Treatments of interest include bisphosphonates or denosumab

Exposure subgroups: different presentation of information (e.g., magnitudes of effects, absolute vs relative effects, number of outcomes presented)

 ■ Context of screening using other BMD or osteoporosis screening tests (e.g., quantitative ultrasound (QUS), quantitative computed tomography (QCT), peripheral DXA (pDXA), trabecular bone score (TBS), bone turnover markers, vertebral fracture assessment, or radiography without BMD)

 ■ Benefit and harm information about other treatments (e.g., hormone therapy, calcitonin, parathyroid hormone, raloxifene, exercise programs +/− other complex interventions, vitamin D, calcium, or other dietary supplements alone)

Comparator

 ■ None

 ■ Non-active exposure: Intervention without information about the possible magnitude of benefits and/or harms of screening or treatment (e.g., pamphlet on bone health or fracture risk factors)

 ■ Information on alternative screening (e.g., tools, intensity) or treatment (e.g., thresholds) strategy (above criteria apply)

See above for exposure

Outcomes

Acceptability measures:

 ■ Willingness or intentions to screen or initiate treatment

 ■ Acceptability of screening or initiating treatment

 ■ Uptake of screening or treatment

 ■ Absolute risk for fracture to make treatment acceptable

 ■ Others as suitable, as reported by authors (e.g., intent to return for another screen, magnitude of benefits to make screening and/or treatment acceptable)

Publication date

 ■ 1995 (introduction of bisphosphonates)

Study design

 ■ Any quantitative study design (e.g., RCT, survey), and quantitative data from mixed methods studies

 ■ Systematic reviews, meta-analyses, and pooled analyses

 ■ Non-research (e.g., editorials, commentaries, opinions)

 ■ Studies available only as conference proceedings or other grey literature, unless data are available and adequate to assess risk of bias

 ■ Qualitative studies

Setting

 ■ Primary health care [117]

 ■ Long-term care or hospital setting