Use of journal clubs and book clubs in pharmacy education: A scoping review.

BACKGROUND: Journal clubs and book clubs are educational activities used in health sciences education to teach evidence-based decision-making, critical thinking, and appraisal skills, and build trainee understanding about important professional issues. The main objective of this scoping review was to identify and synthesize all research studies on journal or book clubs for pharmacy learners. A secondary objective was to identify gaps in the literature where future research would be beneficial to pharmacy educators and learners. METHODS: A comprehensive literature search was run across five databases. Studies were screened using a two stage, blinded, independent screening process. RESULTS: Forty-two studies met all inclusion criteria; 86% reported on journal clubs and 14% on book clubs. Of the journal club studies, 50% were in didactic courses, 33% in experiential education, and 17% were co-curricular initiatives. Of the six book club studies, 67% were within didactic courses and 33% were co-curricular initiatives, including the only interprofessional education study. Most journal clubs were used to teach evidence-based practice, drug literature evaluation, or biostatistics. Book clubs were more focused on soft skills or topics students were less likely to encounter in the core curriculum. IMPLICATIONS: Future research on journal clubs and book clubs in pharmacy education should continue to assess student learning outcomes and abilities. Specifically, future studies should move beyond evaluating student perceptions of journal clubs to investigate effectiveness for topics other than drug literature evaluation or evidence-based practice, and the impact of journal clubs and book clubs on interprofessional knowledge, communication, and team dynamics.

Characterizing Research About Interprofessional Education Within Pharmacy.

Objective. To determine how interprofessional education (IPE) in pharmacy has been studied, namely which disciplines have engaged in IPE research initiatives, the research methodologies that have been used, and what journals have published in this area.Findings. In the 145 IPE studies included in the review, the authors represented 13 different disciplines (3.2±1.5 disciplines per study). Pharmacy authors most commonly published with co-authors from nursing, medicine, and health management and support and most frequently served as first author or last author. The IPE activities involved 4.0 student disciplines (SD = 1.9) and 211.8 students (SD = 280.1), and most commonly included nursing (n = 104, 71.7%), medicine (n = 102, 70.3%), and health management and support students (n = 50, 34.5%). Most studies did not include an author from each student discipline involved in the IPE (n = 88, 60.7%). Further, a majority of studies used nonrandomized groupings (n = 103, 71.0%) with quantitative data (n = 74, 51.0%) and most were published in an interprofessional journal (n = 65, 44.8%) or pharmacy-specific journal (n = 45, 31.0%).Summary. Pharmacists have increased their engagement in IPE research as demonstrated by the number of articles published and authorship order position. However, mismatches between student disciplines and author disciplines on published papers elucidate opportunities to foster collaborations that position students for success within a collaborative healthcare environment.

Establishing the role of the pharmacist in mental health: Implementing Mental Health First Aid into the doctor of pharmacy core curriculum.

INTRODUCTION: The objective of this study was to assess the impact of implementing Mental Health First Aid (MHFA) training in a doctor of pharmacy (PharmD) curriculum on student pharmacists' knowledge, attitudes, self-efficacy, and empathy towards people with mental health conditions and/or crises. METHODS: Participants were third-year PharmD students enrolled in Patient Care Experience, a required communication and ethics course. A survey was administered pre- and post-intervention (i.e. MHFA training). Student pharmacist self-efficacy in assisting someone developing a mental health condition or in crisis was evaluated using confidence measures from the MHFA action plan. Knowledge was measured using Mental Health Knowledge Statements. Attitudes were assessed with the Index of Attitudes Towards Mental Illness, and stigma was evaluated using the Social Distancing Scale. Empathy was measured with the Kiersma-Chen Empathy Scale. RESULTS: Both pre- and post-intervention surveys were completed by 97 of 135 participants (71.9% response rate). MHFA training resulted in significantly increased self-efficacy and empathy. There were no significant differences in knowledge, attitudes, and stigma. CONCLUSIONS: MHFA training was associated with increases in student pharmacist empathy and self-efficacy in providing support to individuals with mental health crises.

Characteristics of High-Performing Interprofessional Health Care Teams Involving Student Pharmacists.

Objective. To identify key themes of interprofessional models of care that offer experiential education opportunities for pharmacy learners. Methods. Six pharmacists from four Area Health Education Centers in North Carolina participated in individual, 60-minute interviews. Using two pre-established frameworks, the data were analyzed qualitatively by two members of the research team to identify the characteristics of interdisciplinary care teams. Results. At the level of the organization or health care system, the theme of appropriate resources and procedures emerged. At the level of the team, the themes of appropriate resources and procedures, communication, appropriate skill mix, climate, quality and outcomes of care, and respecting and understanding roles emerged. At the level of the individual, the themes of communication, respecting and understanding roles, and individual characteristics emerged. Three themes identified in a previous study failed to emerge in the interviews: leadership and management; personal rewards, training and development; and clarity of vision. Conclusion. Although a growing body of evidence highlights the importance of designing practice models to achieve interdisciplinary care that is patient-centered and effective, capacity to support learners and effectively educate them in the principles and practices of team-based care is limited. This study provides critical insight into characterizations of interprofessional models that integrate pharmacy learners. Further research is needed to better understand the barriers to designing and implementing IPE in experiential settings.

Comparing Empathy Levels in Doctor of Pharmacy Students and Exemplary Pharmacist Preceptors.

Objective. To determine how student pharmacists' empathy compares to that of exemplary pharmacist preceptors. Methods. First- through third-year Doctor of Pharmacy students and nominated preceptors demonstrating a model level of empathy in patient care were invited to take the Jefferson Scale of Empathy (JSE) and answer demographic questions. A comparison of total JSE scores was made between students and preceptors. Comparisons of total JSE scores were performed between male and female students, students with and without direct patient care experience, students with and without chronic care experience, and among students based on class year. A factor analysis was completed. Results. The response rate for students and preceptors was 70.3% (n=318) and 73.7% (n=14), respectively. No significant differences in median JSE scores were identified for any of the comparisons. Factor analysis revealed two factors as underlying constructs: "compassionate care" and "perspective taking." Seven of 20 items on the JSE had mean scores >6.0 (possible range 1-7). Conclusion. The majority of students had moderately high cognitive empathy not related to class year that was similar to that of exemplary pharmacist preceptors. A possible ceiling effect was found in several items on the JSE, potentially limiting its use for measuring changes in empathy longitudinally in students with baseline high empathy.

Characteristics of significant events identified by pharmacy students while on early immersion pharmacy practice experiences

OBJECTIVE: The purpose of this study was to characterize and classify significant events of pharmacy students who completed an early practice experience. METHODS: Significant event analyses (SEAs) were reflections submitted by students about events that they found impactful during their early practice experiences. An online repository has stored 287 SEAs submitted by first year pharmacy students for later use in a pharmacy course. For this study, all significant events were read and coded according to the pre-specified themes and tones (positive, negative, neutral, hybrids) of the event. Themes used were derived from prior literature characterizing major themes from other health professional students' experiences. Additional themes were added by authors for those that did not fit into the pre-set categories. All themes of the narratives were subsequently categorized. To assure confirmability, the investigators conferred to discuss new themes that emerged and events that were ambiguous. To assure credibility, an external audit of a sample of the coded SEAs was completed. Upon reaching consensus between primary reviewer and secondary reviewers, data were reported as frequencies and percentages. This study received ethics clearance from the Office of the University Registrar and was deemed exempt by the University Institutional Review Board. RESULTS: A total of 1,055 coded responses were analyzed. The majority of SEAs were positive in tone (n=190, 66.2%) and many were hybrids of negative-turned-positive emotions (n=62, 21.6%). The most common major content theme was "patients and the provision of patient care" (n=412, 39.1%), followed by "pharmacy students and their behavior" (n=260, 24.6%). The most prevalent subthemes were "learning by doing" (n=134, 12.7%) and "feelings of usefulness or uselessness" (n=111, 10.5%). CONCLUSIONS: The majority of students framed significant events in their pharmacy practice experiences in a positive light, even from challenging interactions. The events that resonated most frequently with these students centered around patient interactions and providing patient care. These results will be useful for pharmacy educators developing pharmacy school curriculums to better prepare students to excel and feel more comfortable in direct patient care experiences

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Student perceptions of the value they bring to APPE sites.

INTRODUCTION: Partner institutions invest much time and effort into educating pharmacy students, and ideally students should be viewed as valuable to those sites. Prior studies have demonstrated the perceptions that preceptors and administrators have about the value of students at their sites. However, students' perceptions of their own value at practice sites have not been described. Students do have perceptions about their own value to sites, and such information could be useful in learning about potential areas in which students perceive they are making an impact on patient care. METHODS: Five hundred qualitative student responses to an evaluation question regarding perceived value were analyzed from a United States pharmacy school. Nineteen categories of value were extracted. Responses fit into multiple categories, resulting in 783 data points for analysis. The categories were analyzed overall and with respect to advanced pharmacy practice experience (APPE) type (acute care, community, hospital, ambulatory care, and elective). Descriptive statistics were used. RESULTS: Providing patient counseling (15.7%) and therapeutic recommendations (14.7%) were the highest perceived values. In adult acute care and hospital APPEs, "providing therapeutic recommendations" (24.4% and 19.1% respectively) were rated highest. In community, ambulatory care, and elective APPEs, "providing patient counseling" (25%, 23%, and 13.8%, respectively) was highest rated. CONCLUSIONS: Students perceive they are valuable to practice sites in several ways. These results demonstrate that students' self-reported perceptions of the value they bring to their sites are consistent with other literature reports based on perception of preceptors regarding student value to patient care.

Characteristics of significant events identified by pharmacy students while on early immersion pharmacy practice experiences.

OBJECTIVE: The purpose of this study was to characterize and classify significant events of pharmacy students who completed an early practice experience. METHODS: Significant event analyses (SEAs) were reflections submitted by students about events that they found impactful during their early practice experiences. An online repository has stored 287 SEAs submitted by first year pharmacy students for later use in a pharmacy course. For this study, all significant events were read and coded according to the pre-specified themes and tones (positive, negative, neutral, hybrids) of the event. Themes used were derived from prior literature characterizing major themes from other health professional students' experiences. Additional themes were added by authors for those that did not fit into the pre-set categories. All themes of the narratives were subsequently categorized. To assure confirmability, the investigators conferred to discuss new themes that emerged and events that were ambiguous. To assure credibility, an external audit of a sample of the coded SEAs was completed. Upon reaching consensus between primary reviewer and secondary reviewers, data were reported as frequencies and percentages. This study received ethics clearance from the Office of the University Registrar and was deemed exempt by the University Institutional Review Board. RESULTS: A total of 1,055 coded responses were analyzed. The majority of SEAs were positive in tone (n=190, 66.2%) and many were hybrids of negative-turned-positive emotions (n=62, 21.6%). The most common major content theme was "patients and the provision of patient care" (n=412, 39.1%), followed by "pharmacy students and their behavior" (n=260, 24.6%). The most prevalent subthemes were "learning by doing" (n=134, 12.7%) and "feelings of usefulness or uselessness" (n=111, 10.5%). CONCLUSIONS: The majority of students framed significant events in their pharmacy practice experiences in a positive light, even from challenging interactions. The events that resonated most frequently with these students centered around patient interactions and providing patient care. These results will be useful for pharmacy educators developing pharmacy school curriculums to better prepare students to excel and feel more comfortable in direct patient care experiences.

Preceptor confidence and engagement in providing leadership activities to students in advanced pharmacy practice experiences.

INTRODUCTION: Preceptor perceptions about providing leadership activities during the fourth year of the doctor of pharmacy curriculum were examined. METHODS: An anonymous questionnaire was sent electronically to 610 preceptors of fourth year doctor of pharmacy students in August 2015 inquiring about confidence in leadership ability, extent of student engagement in leadership activities, and preceptor support needed. Differences based on leadership background, such as formal training, were examined using independent t-test. Continuous data are presented as mean (standard deviation). P-value < 0.05 was considered significant. RESULTS: Survey response rate was 28% (n = 171). Preceptor confidence in ability to provide leadership activities was 7.38 + /-1.66 [0-10 Likert scale; 0 = cannot do at all, 10 = highly certain can do]. Preceptors were most confident teaching that leadership comes from those with and without titles (8.48 + /-1.64) and least confident engaging students in advocacy (5.41 + /-3.02). Preceptors were most likely to engage students in collaboration [3(1-4)] and least likely to involve them in advocacy [1(1-4)] (measured from 1-4 with 1 = never and 4 = very often). Preceptors with formal leadership training demonstrated higher confidence and more engagement with involving students in leadership activities than those without training (p < 0.05). Examples of common leadership activities shared by preceptors included experiential clinical activities and projects, teaching opportunities, discussions with leaders, and participation in meetings. Leadership training and development was the most requested type of support by preceptors (n = 23, 13.5%). CONCLUSION: Preceptors were overall confident about their ability to provide leadership activities, were involving students in some leadership activities, and had the least confidence and engagement in involving students in advocacy. Preceptors may consider increasing engagement in teaching student leadership skills by utilizing examples in this study. Colleges of pharmacy and organizations may collaborate to increase preceptor access to formal leadership training programs and offer preceptor development programs designed to enhance preceptors' abilities to facilitate student leadership experience, reflection on experience, and feedback.

Exploring the Requisite Skills and Competencies of Pharmacists Needed for Success in an Evolving Health Care Environment.

Objective. To identify and describe the core competencies and skills considered essential for success of pharmacists in today's rapidly evolving health care environment. Methods. Six breakout groups of 15-20 preceptors, pharmacists, and partners engaged in a facilitated discussion about the qualities and characteristics relevant to the success of a pharmacy graduate. Data were analyzed using qualitative methods. Peer-debriefing, multiple coders, and member-checking were used to promote trustworthiness of findings. Results. Eight overarching themes were identified: critical thinking and problem solving; collaboration across networks and leading by influence; agility and adaptability; initiative and entrepreneurialism; effective oral and written communication; accessing and analyzing information; curiosity and imagination; and self-awareness. Conclusion. This study is an important step toward understanding how to best prepare pharmacy students for the emerging health care needs of society.

Improved Organizational Outcomes Associated With Incorporation of Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center.

PURPOSE: To assess the feasibility of engaging second professional year student pharmacists in the medication reconciliation process on hospital and health system pharmacy practice outcomes. METHODS: Student pharmacists in their second professional year in the Doctor of Pharmacy degree program at our institution were randomly selected from volunteers to participate. Each participant completed training prior to completing three 5-hour evening shifts. Organizational metrics, student pharmacist perception regarding quality of interactions with health care professionals, and pharmacist perceptions were collected. RESULTS: A total of 83 medication histories were performed on complex medical patients (57.0 ± 19.2 years, 51% female, 65% Caucasian, 12 ± 6 medications); of those, 93% were completed within 24 hours of hospital admission. Second professional student pharmacists completed on average 1.9 ± 0.6 medication histories per shift (range 1-3). Student pharmacists identified 0.9 medication-related problems per patient in collaboration with a pharmacist preceptor. Student pharmacists believed the quality of their interactions with health care professionals in the Student Medication and Reconciliation Team (SMART) program was good or excellent. The program has been well received by clinical pharmacists involved in its design and implementation. CONCLUSION: This study provides evidence that second professional year student pharmacists can assist pharmacy departments in the care of medically complex patients upon hospital admission.

Preceptor perceptions of fourth year student pharmacists' abilities regarding patient counseling on therapeutic lifestyle changes.

OBJECTIVE: Advanced pharmacy practice experiences (APPEs) provide an opportunity for students to showcase health and wellness knowledge and skills attained during didactic education. The primary objective of this study was to assess preceptor perceptions of how well pharmacy year four (PY4) students are prepared to provide guideline-based and patient-specific therapeutic lifestyle change (TLC) counseling at onset of an APPE rotation. A secondary objective included assessment of differences in counseling abilities if the preceptor considered the student normal weight versus overweight or obese, or if they were a known smoker. METHODS: A questionnaire containing Likert questions about perceptions regarding TLC counseling was distributed electronically in October 2014 to 708 PY4 preceptors from two pharmacy schools. Only preceptors who routinely provided TLC counseling were included in data analysis that were done using descriptive statistics. The project was approved by both universities' institutional review boards. RESULTS: The survey was completed by 165 PY4 preceptors (response rate = 23.3%), and 67 met inclusion criteria. Regarding nutrition counseling, a greater percentage of preceptors agreed that students more adequately provided counseling per guidelines (79.1%) versus individual patient needs (62.6%). Preceptors perceived students of normal weight were more likely to provide adequate lifestyle-modification counseling to overweight/obese patients (81%) compared to students that were overweight/obese themselves (69%). Students of normal weight were perceived to be more likely to adequately counsel normal weight patients on lifestyle modifications (81%) compared to students that were overweight/obese (64%). Students who smoked were perceived to adequately counsel about not smoking, though, to a lesser degree than students who were non-smokers. IMPLICATIONS: While students are perceived as adequately equipped to provide guideline-based recommendations, there is room for improvement in providing patient-specific counseling. Additionally, it is perceived that student health status related to weight impacts TLC counseling.

Limited Predictive Utility of Admissions Scores and Objective Structured Clinical Examinations for APPE Performance.

OBJECTIVE: To examine the relationship between admissions, objective structured clinical examination (OSCE), and advanced pharmacy practice experience (APPE) scores. METHODS: Admissions, OSCE, and APPE scores were collected for students who graduated from the doctor of pharmacy (PharmD) program in spring of 2012 and spring of 2013 (n=289). Pearson correlation was used to examine relationships between variables, and independent t test was used to compare mean scores between groups. RESULTS: All relationships among admissions data (undergraduate grade point average, composite PCAT scores, and interview scores) and OSCE and APPE scores were weak, with the strongest association found between the final OSCE and ambulatory care APPEs. Students with low scores on the final OSCE performed lower than others on the acute care, ambulatory care, and community APPEs. CONCLUSION: This study highlights the complexities of assessing student development of noncognitive professional skills over the course of a curriculum.

Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center.

OBJECTIVE: To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center. DESIGN: Twenty-two second-year student pharmacists were randomly selected from volunteers, given program training, and scheduled for three 5-hour evening shifts in 2013-2014. Pre/post surveys and reflection statements were collected from 19 students. Data were analyzed with a mixed methods approach. ASSESSMENT: Survey results revealed an increase in student self-efficacy (p<0.05) and positive perceptions of SMART. Qualitative findings suggest the program provided opportunities for students to develop strategies for practice, promoted an appreciation for the various roles pharmacists play in health care, and fostered an appreciation for the complexity of real-world practice. CONCLUSION: Early clinical experiences can enhance student learning and development while fostering an appreciation for pharmacy practice.

Minimum qualifications for clinical pharmacy practice faculty.

The American College of Clinical Pharmacy 2013 Educational Affairs Committee was charged with developing recommendations for the minimum qualifications required for clinical pharmacy practice faculty in United States colleges and schools of pharmacy with respect to education, postgraduate training, board certification, and other experiences. From a review of the literature, the committee recommends that clinical pharmacy practice faculty possess the following minimum qualifications, noting that, for some positions, additional qualifications may be necessary. Clinical pharmacy practice faculty should possess the Doctor of Pharmacy degree from an Accreditation Council for Pharmacy Education­accredited institution. In addition, faculty should have completed a postgraduate year one (PGY1) residency or possess at least 3 years of direct patient care experience. Faculty who practice in identified areas of pharmacotherapy specialization, as identified by American Society of Health-System Pharmacists postgraduate year two (PGY2) residency guidelines, should have completed a PGY2 residency in that area of specialty practice. Alternatively, faculty should have completed a minimum of a PGY1 residency and 1 additional year of practice, with at least 50% of time spent in their area of specialization, which is documented in a portfolio, or 4 years of direct patient care in their area of specialization, which is documented in a portfolio. Fellowship training or a graduate degree (e.g., Ph.D.) should be required for research-intensive clinical faculty positions. All faculty should obtain structured teaching experience during or after postgraduate training, preferably through a formal teaching certificate program or through activities documented in a teaching portfolio. A baseline record of scholarship should be obtained before hire as clinical pharmacy practice faculty through exposure in postgraduate programs or previous employment. Faculty should be board certified before hire or attain board certification within 2 years of hire through the Board of Pharmacy Specialties (BPS) or, if appropriate for the practice area, through a nonBPS-certifying agency. If no certification exists in the area of specialty, the faculty member should develop a portfolio with evidence of excellence in clinical practice, teaching, and scholarship.

A renaissance in pharmacy education at the University of North Carolina at Chapel Hill.

The UNC Eshelman School of Pharmacy is transforming its doctor of pharmacy program to emphasize active engagement of students in the classroom, foster scientific inquiry and innovation, and immerse students in patient care early in their education. The admissions process is also being reengineered.

Characteristics of experiential education web sites of US colleges and schools of pharmacy.

OBJECTIVE: To evaluate the characteristics of experiential education Web sites of colleges and schools of pharmacy in the United States. METHODS: The experiential education Web pages of 124 US colleges and schools of pharmacy were reviewed for office or program name, practice experience management software, experiential education newsletter, practice experience manual, preceptor development programs, new preceptor application processes, and interactive Web site interfaces. RESULTS: The term "office of experiential education" was used by 27.4% of colleges and schools. Fifty percent of the colleges and schools used E-value as their practice experience management software. Only a minority of colleges and schools made experiential manual(s) available online, offered newsletters targeted to preceptors, and/or provided Web site interactive interfaces for preceptor communication. The Preceptors Training and Resource Network was the preceptor development program most frequently promoted. CONCLUSIONS: The majority of US colleges and schools of pharmacy have official Web sites for their experiential education program; however, few offer resources online or use interactive or social media to their advantage.

Helping patients with diabetes: resources from the National Diabetes Education Program.

OBJECTIVES: To familiarize pharmacists with the National Diabetes Education Program (NDEP) and to demonstrate the value of NDEP materials in the care of patients with diabetes. DATA SOURCES: The NDEP website (www.ndep.nih.gov) and PubMed (www.ncbi.nlm.nih.gov/pubmed). SUMMARY: NDEP is a collaboration between the National Institutes of Health, Centers for Disease Control and Prevention, and many organization partners. Since 1997, a large number of materials have been created by NDEP using an evidence-based, expert- and patient-reviewed approach to development. Materials are nonbranded and reflect current medical knowledge and practice. Educational materials are available for persons at risk for diabetes, those with diabetes, family members of persons with diabetes, employers, and professionals. The Pharmacy, Podiatry, Optometry, and Dentistry (PPOD) workgroup of NDEP promotes the value of pharmacists and other professionals in diabetes education and management. Resources are available to educate about the value of the PPOD professionals. CONCLUSION: NDEP provides evidence-based, high-quality educational materials that pharmacists will find useful in the counseling of persons with diabetes.

A new look at established therapies: practical tools for optimizing insulin use.

PURPOSE: Current evidence shows early initiation of insulin therapy in type 2 diabetes mellitus (T2DM) improves glycemic control, responsiveness to subsequent oral antidiabetic therapies, beta-cell function, and possible cardiovascular outcomes. The American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2008 algorithm introduces insulin therapy earlier in the treatment of T2DM with prompt intensification to achieve therapeutic goals. Agent selection and insulin regimens are based on patient A1C levels and willingness to monitor blood glucose, use of previous medications, blood glucose patterns, diet, and lifestyle. Practical considerations offered for diabetes educators and clinicians include creating strategies for early initiation of insulin, addressing patients' psychosocial barriers and quality of life concerns, understanding pharmacokinetic properties of insulin formulations, selecting appropriate therapy and patient-based regimens, and intensifying therapy to achieve glycemic control. CONCLUSIONS: Diabetes education, including intentional curriculum design, for patients with T2DM who are initiating or intensifying insulin therapy, addresses patient barriers to care, reduces the burden of treatment, improves adherence to treatment protocols, and helps optimize clinical outcomes.

Effects of thiazolidinediones on bone loss and fracture.

OBJECTIVE: To examine the evidence regarding the effects of thiazolidinediones on bone loss and fracture. DATA SOURCES: Published studies assessing the effects of thiazolidinediones on bone and/or fracture risk in humans were selected for review. A MEDLINE (1950-April 2007) and International Pharmaceutical Abstracts (1970-April 2007) search was performed. Search terms included thiazolidinediones, rosiglitazone, pioglitazone, troglitazone, bone, bone mineral density, fracture, and osteoporosis. STUDY SELECTION AND DATA EXTRACTION: The literature search retrieved 5 English-language studies evaluating the effects of thiazolidinediones on bone in humans. These consisted of 2 small, uncontrolled studies using troglitazone; 1 prospective, randomized controlled study and 1 retrospective cohort study using rosiglitazone; and a post hoc analysis of an observational cohort study in subjects taking various thiazolidinediones. All of the studies assessed markers of bone metabolism and/or bone mineral density (BMD). No studies were identified that addressed rate of fractures in subjects taking thiazolidinediones. DATA SYNTHESIS: The first troglitazone study demonstrated a decrease in levels of bone formation markers (10%; p < 0.05) and resorption markers (12%; p < 0.01), and authors determined that troglitazone produces a protective effect on bone through decreased bone turnover. The second troglitazone study did not demonstrate a significant change in BMD or levels of bone turnover markers. The 2 rosiglitazone studies demonstrated decreases in BMD of 1.19-1.9% with rosiglitazone use (p < 0.05). The post hoc analysis with various thiazolidinediones indicated a 2.5-fold greater decrease in BMD in women reporting thiazolidinedione use. CONCLUSIONS: Few studies have assessed the effects of thiazolidinediones on bone in humans. Studies available suggest that treatment with thiazolidinediones, primarily rosiglitazone, contributes to bone loss. The effect appears to be most prominent in postmenopausal women. More studies are needed to better understand the effects of thiazolidinediones on bone and fracture rates.