Research
How were osteoporosis options resources developed?
The Osteoporosis Option resources were developed as part of the Improving uptake of Fracture Prevention drug treatments (iFraP) study. This includes the Fracture Liaison Services Consultation Tool and Consultation Skills training.
The iFraP study involved three phases:
RESOURCE DEVELOPMENT
Developing the resources
FEASIBILITY TESTING
Initial testing of the resources at one site
MAIN TRIAL
Testing at 4 sites
Click on the video to learn more about how we developed the resources
Our scientific publications are listed at the bottom of this page.
Key findings of the development work
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Approximately one quarter of specialist osteoporosis services do not discuss osteoporosis medicines with patients
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GPs reported lacking confidence in discussing osteoporosis medicine with patients
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Patient information about osteoporosis medicines was found to be too complex, contains contradictions and was not balanced
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Patients reported being uncertain about the need for treatment and treatment benefits
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Fracture prevention nurses and allied health professionals reported needing help with how to communicate risk
Main trial findings (2022 – 2024)
The developed resources were tested as part of a randomised controlled trial in four Fracture Liaison Services in England. 347 patients took part in the trial, half of whom were allocated to receive the Osteoporosis Options resources in their Fracture Liaison Service appointment and the other half received a standard Fracture Liaison Service appointment. All patients were asked to complete questionnaires before and after their appointment.
Overall, the trial found that patients who received the resources reported:
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Easier decision-making about osteoporosis medicines
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Increased person-centred care
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Greater satisfaction with written and verbal information
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Greater accuracy of fracture risk perceptions
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Higher perceived need for osteoporosis medicines
Further development of the resources and linked studies
We identified the need to widen the accessibility, applicability and impact of the Osteoporosis Options resources for use in primary care settings.
We developed two new additional tools, including:
1. Osteoporosis Options health professional decision tool
A standalone clinical support tool for other health professionals e.g. GPs, practice-based pharmacists.
2. Osteoporosis Options patient & carer treatment decision tool
A standalone patient information resource that can be accessed by patients and carers. To help shape this tool, we worked closely
To complement these tools, we developed additional training modules to help address GP and practice-based pharmacist training needs.
We developed these through linked studies:
A person-centred primary care pharmacist-led osteoporosis review for optimising medicine (PHORM)
Interviews with a wide range of health professionals across primary and secondary care exploring the role of practice-based pharmacists, their perceptions of a new osteoporosis review and their training needs.
Improving understanding of bone density (DXA) scans (INDEX)
Interviews and consensus work with patients and health professionals across primary and secondary care exploring how understanding and communication about bone density scans can be improved.
Investigating the osteoporosis care gap in primary care
A national survey and interviews with primary care staff to explore current practice and training needs when providing osteoporosis care in primary care.
Other resources and information
We’ve partnered with Royal Osteoporosis Society to develop ERO hub, a library of evidenced-based resources for osteoporosis.
The resources are all generated from high quality research, including the iFraP and linked studies, and for use by healthcare professionals and members of the public.
Examples include information leaflets, clinical forms, decision aids, questionnaires, videos and podcasts. We also have a bitesize clinical guideline section with handy flowcharts from key guideline documents.
All of the evidence-based resources on the ERO website have been reviewed by a group of experts in osteoporosis care and relevant stakeholders including members of the public.
Click here to find out more: https://erohub.co.uk/
Click here to find out more about other research studies being conducted by the Keele osteoporosis Research Group. Research groups – Keele University
Scientific Publications
To learn more about why we decided to develop the resources
Paskins Z, Torres Roldan VD, Hawarden AW, Bullock L, Meritxell S, Torres GF, Morera L, Espinoza Suarez NR, Worrall A, Blackburn S, Chapman S, Jinks C, Brito JP. 2020. Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan. Osteoporos Int, vol. 31(10), 1837-1851. https://doi.org/10.1007/s00198-020-05479-w
Hawarden A, Jinks C, Mahmood W, Bullock L, Blackburn S, Gwilym S, Paskins Z. 2020. Public priorities for osteoporosis and fracture research: results from a focus group study. Arch Osteoporos, vol. 15(1), 89. https://doi.org/10.1007%2Fs11657-020-00766-9
Paskins Z, Jinks C, Mahmood W, Jayakumar P, Sangan CB, Belcher J, Gwilym S. 2017. Public priorities for osteoporosis and fracture research: results from a general population survey. Arch Osteoporos, vol. 12(1), 45. https://doi.org/10.1007/s11657-017-0340-5
Raybould G, Babatunde O, Evans AL, Jordan JL, Paskins Z. 2018. Expressed information needs of patients with osteoporosis and/or fragility fractures: a systematic review. Arch Osteoporos, vol. 13(1), 55. https://doi.org/10.1007/s11657-018-0470-4
Crawford-Manning F, Greenall C, Hawarden A, Bullock L, Leyland S, Jinks C, Protheroe J, Paskins Z. 2021. Evaluation of quality and readability of online patient information on osteoporosis and osteoporosis drug treatment and recommendations for improvement. Osteoporos Int. vol. 32(8):1567-1584. https://doi.org/10.1007/s00198-020-05800-7
To learn more about how we developed the resources
Paskins Z, Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards JJ, Clark E, Thomas S, Chapman SR, Ryan S, Lefroy JE, Gidlow CJ, Iglesias C, Protheroe J, Horne R, O’Neill TW, Mallen C, Jinks C. 2021. Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D). BMJ Open. Vol. 18;11(8). https://doi.org/10.1136/bmjopen-2021-048811
Bullock L, Tyler N, Clark EM, Thomas S, Gidlow C, Bentley I, Hawarden A, Peel N, Gregson CL, Ralston SH, Protheroe J. The Michael Mason Prize: Development and feasibility testing of a complex intervention to improve adherence to fracture prevention medicine using a person-centred approach. Rheumatology. 2025.
Bullock L, Manning F, Hawarden A, Fleming J, Leyland S, Clark EM, et al. Exploring practice and perspectives on shared decision-making about osteoporosis medicines in Fracture Liaison Services: the iFraP development qualitative study. Arch Osteoporos 2024;19:50
Bullock L, Abdelmagid S, Fleming J, Leyland S, Clark EM, Gidlow C, et al. Variation in UK Fracture Liaison Service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey. Arch Osteoporos 2023;
Bullock L, Crawford-Manning F, Cottrell E, Fleming J, Leyland S, Edwards J, et al. Developing a model Fracture Liaison Service consultation with patients, carers and clinicians: a Delphi survey to inform content of the iFraP complex consultation intervention. Arch Osteoporos [Internet] 2021 [cited 2021 Aug 5];16:1–17. Available from: https://link.springer.com/article/10.1007/s11657-021-00913-w
Bullock et al…Development and feasibility testing of a complex intervention to improve adherence to fracture prevention: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keaf413/8238736
Exploring practice and perspectives on shared decision-making about osteoporosis medicines in Fracture Liaison Services: the iFraP development qualitative study: https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/keaf413/8238736
Variation in UK Fracture Liaison Service consultation conduct and content before and during the COVID pandemic: results from the iFraP-D UK survey: https://link.springer.com/article/10.1007/s11657-023-01361-4
To learn more about how we tested the resources
Bullock L, Nicholls E, Cherrington A et al. A person-centred consultation intervention to improve shared decision-making about, and uptake of, osteoporosis medicines (iFraP): a pragmatic, parallel-group, individual randomised controlled trial protocol [version 2; peer review: 3 approved, 1 approved with reservations]. NIHR Open Res 2024, 4:14 (https://doi.org/10.3310/ .13571.2)
Bullock L, Cherrington A, Clark EM et al. Protocol for a mixed methods process evaluation for a randomised controlled trial to improve shared decision-making about, and uptake of, osteoporosis medicines: the iFraP study [version 1; peer review: 1 approved]. NIHR Open Res 2024, 4:70 (https://doi.org/10.3310/nihropenres.13751.1)
Siciliano M, Bathers S, Bentley I et al. Protocol for a trial-based economic evaluation analysis of a complex digital health intervention including a computerised decision support tool: the iFraP intervention [version 1; peer review: awaiting peer review]. NIHR Open Res 2024, 4:15 (https://doi.org/10.3310/nihropenres.13575.1)
To learn more about the linked studies
Sturrock A, Grabrovaz M, Bullock L, Clark E, Finch T, Haining S, Helliwell T, Horne R, Hyde R, Maidment I, Pryor C. A person-centred primary care pharmacist-led osteoporosis review for optimising medicines (PHORM): a protocol for the development and co-design of a model consultation intervention. BMJ open. 2024 Nov 1;14(11):e085323.
Kettle C, Manning F, Henderson B, Griffin J, Knapp K, Butterworth J, Jinks C, Bullock L, Paskins, Z. Optimising patient and health professional understanding and communication of bone density scans: A qualitative and group consensus study.
Sturrock et al: https://bmjopen.bmj.com/content/14/11/e085323
Hawarden, A., Bullock, L., Cox, N. M., Nicholls, E., Protheroe, J., Jinks, C., & Paskins, Z. (2025). Osteoporosis care in primary care settings: a national UK e-survey. Archives of Osteoporosis, 20(1), Article 109. https://doi.org/10.1007/s11657-025-01591-8
Hawarden, A., Bullock, L., García, M. L., Hartasanchez, S. A., Maraboto, A., Jinks, C., Kunneman, M., Hargraves, I., Horne, R., Montori, V. M., & Paskins, Z. (2025). Getting to what matters for people with osteoporosis in clinical consultations with and without conversation aids: A videographic analysis. Patient Education and Counseling, 137(August 2025), Article 109171. https://doi.org/10.1016/j.pec.2025.109171