title: Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial.
abstract: OBJECTIVE
  Poor adherence to therapy, perhaps related to unaddressed patient preferences, limits the effectiveness of osteoporosis treatment in at-risk women. A parallel patient-level randomized trial in primary care practices was performed.
  
  
  METHODS
  Eligible postmenopausal women with bone mineral density T-scores less than -1.0 and not receiving bisphosphonate therapy were included. In addition to usual primary care, intervention patients received a decision aid (a tailored pictographic 10-year fracture risk estimate, absolute risk reduction with bisphosphonates, side effects, and out-of-pocket cost), and control patients received a standard brochure. Knowledge transfer, patient involvement in decision-making, and rates of bisphosphonate start and adherence were studied. Data came from medical records, post-visit written and 6-month phone surveys, video recordings of clinical encounters, and pharmacy prescription profiles.
  
  
  RESULTS
  A total of 100 patients (range of 10-year fracture risk, 6%-60%) were allocated randomly to receive the decision aid (n=52) or usual care (n=48). Patients receiving the decision aid were 1.8 times more likely to correctly identify their 10-year fracture risk (49% vs 28%; 95% confidence interval [CI], 1.03-3.2) and 2.7 times more likely to identify their estimated risk reduction with bisphosphonates (43% vs 16%; 95% CI, 1.3-5.7). Patient involvement improved with the decision aid by 23% (95% CI, 13.6-31.4). Bisphosphonates were started by 44% of patients receiving the decision aid and 40% of patients receiving usual care. Adherence at 6 months was similarly high across both groups, but the proportion with more than 80% adherence was higher with the decision aid (n=23 [100%] vs n=14 [74%]; P = .009).
  
  
  CONCLUSIONS
  A decision aid improved the quality of clinical decisions about bisphosphonate therapy in at-risk postmenopausal women, did not affect start rates, and may have improved adherence.
authors: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. kerunit@mayo.edu
authors: Victor M
authors: VM
authors: Montori
authors: Nilay D
authors: ND
authors: Shah
authors: Laurie J
authors: LJ
authors: Pencille
authors: Megan E
authors: ME
authors: Branda
authors: Holly K
authors: HK
authors: Van Houten
authors: Brian A
authors: BA
authors: Swiglo
authors: Rebecca L
authors: RL
authors: Kesman
authors: Sidna M
authors: SM
authors: Tulledge-Scheitel
authors: Thomas M
authors: TM
authors: Jaeger
authors: Ruth E
authors: RE
authors: Johnson
authors: Gregory A
authors: GA
authors: Bartel
authors: L Joseph
authors: LJ
authors: Melton
authors: Robert A
authors: RA
authors: Wermers