We then classified the level of risk of bias based on whether there was little evidence that the bias

would impact study results (low) or if some evidence suggested that the bias may have impacted study results (high). We did not use a more fine assessment to identify medium risk of bias. Results Of the 611 unique English language publications identified from the database searches, 118 were pulled for detailed H 89 price review and one additional publication [11] was found from the manual search of reference lists, Fig. 1. No grey literature was identified. Of the 119 publications reviewed, 25 examined pharmacist interventions in osteoporosis management: 16 cohort [12–27], five cross-sectional [28–32], one historical/ecological control [33], and three RCTs [34–36]. Of the three RCTs, two were cluster RCTs that involved the randomization of

pharmacies/pharmacists rather than randomization of single patients [34, 35]. Characteristics of the three RCTs are summarized selleck chemicals llc in Table 1, and potential biases are summarized in Table 2. Fig. 1 Flow chart of literature search strategy. IPA International Pharmaceutical Abstracts. *no grey literature identified from our primary search however (Appendix Table 5) Table 1 Characteristics of randomized controlled trials of osteoporosis interventions in pharmacy practice Study, Design, Setting Inclusion

Criteria Training Recruitment Groups n Description Crockett et al. [34] • Women >40 years • 7-h training session • Ads in local newspaper Non-BMDa (6 sites) 98 (84)e • Pharmacist completed risk assessment using a questionnaire to categorize patients as: low, medium, or high risk Cluster RCTa, Australia (New South Wales) • Men >50 years • Information package • Notices in participating pharmacies     • All counselled find more regarding lifestyle modifications 12 community pharmacies • No BMD test in prior 2 years • On-site visit to check protocol • Participants called to book appointment     • High and medium risk: encouraged to follow-up with general practitioner   • No prior OP treatment     BMDa (6 sites) 119 (114)e • Same as above; however, forearm DXA also used to classify risk (low, T > −1.0; medium, −1.0 ≥ T > −2.5; or high, T ≤ −2.5)               McDonough et al. [35] • ≥18 years • 4-h classroom education • Patients identified from dispensing records and recruited by mail Control (7 sites) 26 (19)e • Usual care Cluster RCTb, United States (Eastern Iowa) • Taking ≥7.