Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Julie A. Koch


Osteoporosis is characterized by reduction of bone mass and compromised bone strength, resulting in an increased fracture risk. Since a reduction of bone mass has been shown to be predictive of future fracture risk, prevention strategies target screening those patients at risk for decreased bone mass by using bone mineral density (BMD) dual energy x-ray absorptiometry (DXA) scans. Current national guidelines recommend that all women 65 years and older undergo BMD testing using central DXA every two years. Despite these recommendations, women age 65 years and older still do not participate in this screening. Greater rates of osteoporosis screening could be achieved by identifying an efficient, effective way for healthcare providers and patients to schedule DXA scans. The purpose of this EBP project was to determine if a mailed patient reminder would increases BMD screening rates in women at risk for osteoporosis, as compared to the previous practice of provider recommendation during a scheduled visit. The Stetler Model was used to guide the EBP project, and Kotter and Cohen’s eight steps for successful change provided support for the behavioral change. The population of focus consisted of female Medicare recipient’s age 65 years and older who were active patients within a Midwestern community care clinic in the fall of 2013. Overall, the mailed reminder for osteoporosis screening demonstrated effectiveness in improving BMD screening rates. At the end of the 12-week project, the percentage of female Medicare recipients who were up to date in their BMD screening increased from 17.07% to 31.40%. Those participating in BMD screening during the 12-intervention intervention period ranged in age from 65 to 98. Of the 47 female patients who were not up to date and had a DXA scan as a result of the intervention, a significantly larger percentage were patients of the physician (87.23%) versus patients of the NP (12.77%) who focused on women's wellness during routine office visits (χ² = 9.824, p = .002).