JMIR Publications

ABSTRACT

Background:

Osteoporosis care remains largely reactive and hospital-based, which may leave adults with modifiable bone health–related risks outside routine awareness and evaluation pathways before a fracture occurs. Public-facing digital self-assessment tools may help extend early bone health awareness beyond conventional clinical settings.

Objective:

This study aimed to evaluate a public-facing web-based bone health self-assessment tool in Thailand by characterizing user risk profiles, identifying potentially overlooked at-risk users, and exploring associations with self-reported fracture history.

Methods:

We conducted an exploratory quantitative cross-sectional study using anonymous completed assessments collected through a public-facing web application. Participants were recruited through the hospital’s public social media channels and outpatient department display screens. The application collected self-reported demographic, clinical, and lifestyle-related information and generated user-facing outputs including a bone health score, score category, percentile ranking, and personalized recommendations. Primary outcomes were descriptive and included participant characteristics, distribution of modifiable bone health–related risk factors, tool-generated score categories, and potentially overlooked at-risk users. Secondary exploratory analyses examined associations between selected self-reported variables and fracture history.

Results:

A total of 261 completed assessments were analyzed. Participants had a mean age of 51.8 (SD 13.5) years, and 200/261 (76.6%) were female. Self-reported fracture history was present in 43/261 (16.5%) users. Overall, 89/261 (34.1%) users had suboptimal score profiles, and 154/261 (59.0%) had at least 2 unfavorable modifiable factors. Users younger than 60 years were more likely than those aged 60 years or older to have suboptimal score profiles (66/159, 41.5% vs 23/102, 22.5%; P=.003), modifiable risk burden of 2 or more deficits (108/159, 67.9% vs 46/102, 45.1%; P<.001), and modifiable risk burden of 3 or more deficits (73/159, 45.9% vs 24/102, 23.5%; P<.001). Among users with suboptimal score profiles, 66/89 (74.2%) were younger than 60 years and 63/89 (70.8%) had no self-reported fracture history. In secondary exploratory analyses, increasing age (adjusted odds ratio [aOR] 1.05, 95% CI 1.02-1.08; P=.002) and any fall history (aOR 5.76, 95% CI 2.72-12.17; P<.001) were associated with self-reported fracture history, whereas combined adequacy of calcium intake and vitamin D exposure was associated with lower odds of fracture history after age adjustment (aOR 0.43, 95% CI 0.20-0.95; P=.037).

Conclusions:

This exploratory cross-sectional study suggests that a public-facing web-based bone health self-assessment tool can reveal substantial modifiable risk burdens in real-world users, including younger and fracture-free adults who may otherwise remain unrecognized in routine osteoporosis-focused care pathways. By translating self-reported information into understandable risk categories and personalized recommendations, the tool may support earlier awareness of actionable bone health concerns and complement existing care pathways by prompting timely follow-up when appropriate.