Supplemental Material for: 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)

Methods

Primary behavioral and compliance 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 family-wise error rate control handled via a Bonferroni-corrected significance threshold set at P<0.0167. </p><p dir="ltr">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). </p><p dir="ltr">Limitations: The study is constrained by an inherent risk of patient self-selection bias due to its non-randomized nature, alongside confounding variations in follow-up frequencies between the two management arms. </p><p dir="ltr">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. </p>