Clinicians are trained in interpreting risk in our daily practice. Although we understand the concept of absolute benefit and absolute harm rates, communicating such figures in a clear and intuitive way to patients is no easy task. And we do not of course work in a vacuum. Patient decisions are influenced by other healthcare providers, and in some circumstances those providers will be the actual prescribers and the gatekeepers for testing and treatment. Relative risks are fairly easy to communicate but are strongly misleading when comparing events that differ in likelihood. The current example in osteoporosis is explaining to patients that the risk of osteonecrosis of the jaw (ONJ) or atypical femoral fracture (AFF) pales in comparison to the benefit of treatment. To patients, a relative reduction of some 30% to 50% in the risk of clinical fractures appears small compared with a threefold increase in the risk of osteonecrosis or a—still controversial—100-fold increase in the risk of AFFs. A more useful tabulation based on the absolute rates of various events and of osteoporotic fractures in high-risk individuals can be found in the ASBMR Task Force report.1 The declining use of anti-osteoporosis medications in many countries reflects the genuine concern among physicians that they will be held accountable for all adverse events while not being credited for the fractures they have prevented. Professional opinions can hardly be expected to be uniform even with the existence of guidelines. But when health professionals disagree strongly about whether prescribing for a medical condition is justified or not, treatment gaps will widen even in the presence of the best patient education. For example, providing patients with a consistent health message is difficult when family physicians are encouraged to regard BMD testing and spine X-rays (two critical components of detecting and grading osteoporosis) as low-value tests.2 We are under increasing pressure to keep consultations with patients short and effective; hence, thinking outside the box is necessary to provide patients with good quality information about osteoporosis and treatment options in a cost-effective way. For all interventions, whether educational or pharmaceutical, physicians and health planners require good data on benefits, harms, and costs. The potential for nonpharmaceutical interventions to cause harm is sometimes overlooked. In this issue of the JBMR, Danila and colleagues3 report on the outcomes of a randomized, targeted video education program delivered to postmenopausal women with a history of prior fractures who participated in the Global Longitudinal Study of Osteoporosis in Women (GLOW) at selected centers. The study is interesting both because it tested a type of intervention that could very easily be moved to a mobile phone app platform and because of the unexpected results. The primary outcome of the study was defined a priori as the number of women starting osteoporosis treatment within 6 months after the intervention, with secondary outcomes being BMD testing and initiation of calcium and vitamin D supplements. The hope was that the intervention would lead to more women in the intervention arm beginning osteoporosis treatment. When evaluated using the intention-to-treat (ITT) principle, there were no significant differences in the primary or secondary outcomes between the intervention group and the control group. Overall, differences were small. Women in the intervention group became slightly more concerned about the risk of ONJ. The differences were more pronounced in an as-treated type sensitivity analysis where women in the intervention group who watched under 20 s of the video were excluded from the analysis. Done in this way, the analysis also found an even larger increase in the number of women who regarded ONJ as a barrier to treatment, and a larger proportion of women in the intervention group responded that they were ready to contemplate making a change in their attitude to osteoporosis treatment. There was a significant increase in use of nonbisphosphonate osteoporosis medications but not in the use of bisphosphonates. Clearly—and this should not surprise us—as patients we are prone to negativity bias4 and to the availability heuristic.5 In simple terms, this means we attribute greater weight to potential harms—and especially those that we have recently been alerted to or seen examples of—than to potential gains, even when the latter outcomes have much higher probability. Where do we go from this? In accordance with the conclusions by the authors it is challenging to achieve changes in osteoporosis care by patient activation alone. Both a prescription for osteoporosis treatment and a referral for BMD measurement requires that not only the patient but also their physician agrees that to do so would be justified. This may certainly differ by culture and by type of healthcare system, so results may not be universally applicable. The most unusual thing about the study participants was that two-thirds had received some form of osteoporosis preventive medication in the past. However, this includes estrogen treatment, which may not have been prescribed for skeletal reasons alone. A fully treatment-naive cohort could have responded differently and perhaps more favorably to the study intervention. Further, primary outcome data was missing in a large number of study participants, leaving readers with some uncertainty about the treatment uptake rates (11.4% in the control group in the ITT analysis, 6.8% in the per-protocol analysis). This aside, a strong point of the study is that the intervention, though to some extent individually tailored, was fairly uniform and thus probably more reproducible than would be the case for a nurse-led information session, for example. The authors should also be praised for sharing the videos with the readers to fully document the type of intervention employed. Making these videos available to fellow researchers is also important because the messages about osteoporosis treatment can be delivered with subtle differences in the emphasis on harms or benefits with the potential for some educational material to deliver a rosier message than others. Clearly some educational material is more effective than other material so we do not know for certain that subtly different video presentations could not have resulted in a different set of patient choices. If we are to tackle osteoporosis well, the importance of successful shared care with primary care practices cannot be stressed enough. It is not possible to provide a detailed review of prior studies in this Commentary but readers are referred to the recent Cochrane review.6 In brief, a combination of a general practitioner (GP) alerting system, patient education, and a reminder to patients about consulting their family physician strongly increased testing and treatment rates in osteoporosis, with primary practice engagement a more significant contributor than patient education. Published after the Cochrane review, a national quality improvement program in Australia confirmed positive outcomes regarding testing and treatment with stakeholder and patient engagement.7 In conclusion, evaluation of current practices and interventions for providing patients with good quality information about osteoporosis and treatment options in a cost-effective way is urgently needed as a crucial step to tackle the current crisis in osteoporosis treatment. BA reports research contracts with Novartis and UCB with funds paid to the institution.