Nurse-Led Supportive Physical and Psychological Therapies versus Orthopedic Specialist-Led Usual Care for Postmenopausal Women with Osteoporosis: A 24-Month Prospective, Non-Randomized Interventional Study with Retrospective Data Analysis (Quasi-Experimental Design).

BACKGROUND

Postmenopausal osteoporosis is a progressive skeletal disorder that poses a substantial public health burden due to increased fracture risks. Specialized orthopedic clinics are often structurally constrained by high surgical volumes, limiting their capacity to provide the continuous cognitive reinforcement necessary to maintain long-term medication compliance. Objectives of the study were to evaluate the 24-month clinical utility, behavioral outcomes, and safety profiles of a nurse-led supportive physical and psychological therapy (NT) model compared with traditional orthopedic specialist-led usual care (OU) in postmenopausal women with newly diagnosed primary osteoporosis.

METHODS

This 24-month quasi-experimental, non-randomized prospective interventional study analyzed registry data from January 2020 to July 2022 at a single center in China. Out of 415 screened postmenopausal women, 381 with complete 24-month data were evaluated (NT cohort: n = 190, receiving monthly theory-based counseling; OU cohort: n = 191, receiving standard quarterly visits). Both groups received standard guideline-directed medical therapy. Primary metrics included the Medication Possession Ratio (MPR), Osteoporosis Self-Efficacy Scale (OSES), and Osteoporosis Health Belief Scale (OHBS). Separate multivariable linear and logistic regression models adjusted for baseline covariates, with a Bonferroni-corrected significance threshold set at P < 0.0167.

RESULTS

Baseline demographic and clinical parameters were well-matched between the two cohorts. From baseline to the 24-month endpoint, within-group analyses showed significant improvements in psychological indices for both cohorts (P < 0.001). However, inter-group comparisons at 24 months revealed significantly higher health belief scores in the NT cohort (P < 0.001) and markedly superior personal satisfaction (median 2 vs. 1; P < 0.0001). Continuous median MPR was higher in the NT group (0.76) than the OU group (0.74; P = 0.0006). Crucially, 34.7% of the NT cohort achieved the optimal therapeutic adherence threshold (MPR ≥ 0.80) compared to 20.4% in the OU cohort. Multivariable logistic regression confirmed that allocation to the nurse-led framework was associated with a 3.45-fold increase in the odds of achieving optimal adherence (aOR = 3.45; 95% CI: 1.85-6.42; P = 0.0006). Exploratory safety observations recorded zero deaths in the NT group and six descriptive deaths in the OU group (P = 0.032).

CONCLUSIONS

A structured nurse-led supportive care model is strongly associated with higher rates of optimal medication adherence and more robust improvements in health beliefs among postmenopausal women with osteoporosis compared to standard orthopedic care. While patient self-selection and confounding follow-up frequencies necessitate interpreting these findings as longitudinal clinical associations rather than definitive causal effects, this collaborative nursing framework offers a promising operational strategy to alleviate follow-up constraints in high-volume specialized healthcare systems.