JMIR Publications

ABSTRACT

Background:

Osteoporosis remains a significant global health challenge, yet treatment uptake and long-term adherence remain low, increasing the risk of future fragility fractures. Common barriers to effective management include limited patient awareness, financial pressures, and the practical difficulties associated with ongoing monitoring and follow-up care. While mobile health and telemedicine tools have shown potential in supporting chronic disease management, recent evidence suggests that many existing osteoporosis applications lack clear clinical validation and rarely include structured medication management features.

Objective:

This study aimed to evaluate the feasibility of implementing a newly developed web-based application, Wellhealth, to support osteoporosis treatment management. A secondary objective was to explore potential associations between patient demographic characteristics and the frequency of in-app medication logging over a one-year period.

Methods:

We conducted a feasibility study at the Golden Jubilee Medical Center, Mahidol University, between January 2023 and March 2025, involving patients diagnosed with primary osteoporosis. Patients with severe chronic kidney disease, medication allergies, cognitive or literacy limitations, or an inability to use a smartphone were excluded from the study. Participants used the Wellhealth web-based system, including the Assisted Liaison Service feature, to support medication management through reminders and real-time feedback. Weekly health surveillance was also conducted, incorporating brief self-assessments of quality of life and monitoring for adverse events. After one year, we evaluated in-app medication logging, satisfaction with app use, patterns of user interaction, self-reported quality of life, and preliminary associations with medication logging behavior using data collected from the application database. Feasibility outcomes were summarized using descriptive statistics. Potential associations between participant characteristics and consistent in-app medication logging were explored using univariable and multivariable logistic regression analyses. Differences between in-app medication logging rates and medication possession ratio values were summarized using medians and interquartile ranges.

Results:

We enrolled 32 participants with a mean age of 71 years (range, 58–91 years). The average in-app medication logging rate was 62.38% for anti-osteoporosis medications and 64.67% for calcium supplementation. Vitamin D logging data were available for 27 participants, with an average logging rate of 68.23%. Overall satisfaction with the application was high, with 49% of participants reporting high satisfaction, 42% reporting good satisfaction, and 9% reporting average satisfaction. User interaction with the application was generally consistent over time, increasing markedly between the first and third quarters of 2023 before stabilising through the second quarter of 2024. In multivariable analysis, consistent calcium logging was the only factor independently associated with higher anti-osteoporosis medication logging rates (P = 0.018). Although younger age was associated with higher logging rates in univariable analysis (P = 0.011), this association was no longer significant after multivariable adjustment (P = 0.117).

Conclusions:

The use of the Wellhealth system appeared feasible within this small cohort, as reflected by satisfactory medication logging consistency, high user acceptability, and sustained digital engagement over time. Consistent calcium logging was the only independent factor associated with higher tracking rates for anti-osteoporosis medications. Larger-scale studies are needed to further evaluate the clinical effectiveness of the application and its potential impact on long-term treatment outcomes.