Osteoporosis International

, Volume 28, Issue 2, pp 567–576 | Cite as

A pilot randomized controlled trial of a decision aid with tailored fracture risk tool delivered via a patient portal

  • A. J. SmallwoodEmail author
  • M. M. Schapira
  • M. Fedders
  • J. M. Neuner
Original Article



We tested the feasibility of a fracture prevention decision aid in an online patient portal. The decision aid was acceptable for patients and successfully decreased decisional conflict. This study suggests the possible utility of leveraging the patient portal to enhance patient education and decision making in osteoporosis care.


Although interventions have improved osteoporosis screening and/or treatment for certain populations of high-risk patients, recent national studies suggest that large-scale uptake of these interventions has been limited. We aimed to determine the feasibility and potential efficacy of a patient portal-based osteoporosis decision aid (DA).


We conducted a pilot randomized controlled trial of primary care patients aged ≥55 who were enrolled in a patient portal and had a T-score of <−1. Intervention subjects were provided a link to a patient DA. The DA contained a 10-year fracture risk calculator, summary of medication risks and benefits (prescription and nonprescription), and an elicitation of values. Subjects completed questionnaires assessing the primary outcomes of decisional conflict and preparation for decision making and secondary outcomes related to feasibility and planning for a larger trial. Charts were reviewed for physician-subject interactions and medication uptake.


The DA was acceptable to subjects, but 17 % of the patients in the decision aid arm incorrectly entered their T-scores into FRAX-based risk calculator. Decisional conflict was lower post-intervention for those who were randomized to the decision aid arm compared to controls (17.8 vs. 47.1, p < .001), and there was a significant difference in the percentage of patients who made a treatment decision at 3 months. No significant differences were observed in medication uptake.


A portal-based osteoporosis DA was acceptable and improved several measures of decision quality. Given its effect on improving the quality of patients’ decisions, future studies should examine whether it improves physician guideline adherence or medication adherence uptake among treated patients.


Decision aids Osteoporosis Patient portal Personalized risk Shared decision making 



A special thanks to Glenn Bushee for his invaluable assistance in the development of the decision aid and to the Agency for Healthcare Research and Quality and staff at John M. Eisenberg Center for Clinical Decisions and Communications Science for making their decision aid publically available.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


This study was funded by the Clinical and Translational Science Institute of Southeast Wisconsin (project number 5,520,204).

Conflicts of interest


Supplementary material

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • A. J. Smallwood
    • 1
    Email author
  • M. M. Schapira
    • 2
    • 3
  • M. Fedders
    • 4
  • J. M. Neuner
    • 1
    • 5
  1. 1.Center for Patient Care and Outcomes ResearchMedical College of WisconsinMilwaukeeUSA
  2. 2.Division of General Internal Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Center for Health Equity Research and Promotion, Crescenz VA Medical CenterPhiladelphiaUSA
  4. 4.Clinical InformaticsFroedtert and the Medical College of WisconsinMilwaukeeUSA
  5. 5.Division of General Internal Medicine, Department of MedicineMedical College of WisconsinMilwaukeeUSA

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