Background/Purpose: In this era of modern medicine, health care providers and patients are partners in making decisions about treatment. It is imperative that evidence-based medicine be translated into a patient-friendly format, in which pros and cons of treatment options are compared. A simple-to-follow decision aid allows integration of patient preferences, values and circumstances with up to date science, keeping in mind the challenge of integrating this system in a busy clinical practice. Previous studies have shown that this approach enhances patient and provider satisfaction.

Methods: Several prior studies have explored the factors that matter when patients make treatment choices—these include adverse effect profile, efficacy, cost of medication, and opinion of heath care provider. Currently there is no decision aid available for osteoporosis that incorporates all the treatment options approved by the Food and Drug Administration (FDA) and considers the American College of Rheumatology (ACR) – Glucocorticoid Induced Osteoporosis 2010 guidelines.  We included clinical risk factors for development of osteoporosis, computed a list of osteoporosis medications approved by FDA, searched through meta-analyses for evidence based efficacy and effect (odds ratio), cost, and side effects of the agents. We referenced National Osteoporosis Foundation Guidelines (NOF) and US Preventive Services Task Force (USPSTF) for screening and treatment guidelines, and for glucocorticoid induced osteoporosis we referred the ACR 2010 guidelines.

Results: We created a personalized evidence-based shared decision making tool, envisioned to be used at an outpatient visit in primary care or specialty center.  The clinician and patient start by documenting clinical risk factors, after which, with the help of a computer algorithm, the 10 year risk of a major osteoporotic fracture or hip fracture is calculated.  A personalized report is generated which uses NOF guidelines to determine whether initiation of medication is advised.  Next, the patient and provider review efficacy of medications tailored specifically to the patient’s risk of an osteoporotic fracture within 10 years and how it would be altered by taking a particular medication (Fig 1). The side effect profile, form, frequency and cost of medications are included. Finally, after the patient makes an informed decision in conjunction with the clinician, an individualized report can be printed and be given to the patient with specific instructions at the end of visit.

Conclusion: We developed an interactive, colorful, easy to follow, online tool, integrating evidence based medicine and patient preferences, which has the potential to help providers in delivering optimal patient care.  We are in the process of validating the tool and gathering patient and provider satisfaction scores at our institution.

Figure 1: Screenshot from Shared Decision Making tool for Osteoporosis Treatment options.