Purpose <p>This study aimed to assess the impact of customized educational tools for improving disease awareness, shared decision-making effectiveness, and medical satisfaction among patients with osteoporotic vertebral fractures.</p> Methods <p>This prospective non-randomized controlled study included patients with radiographically confirmed vertebral fractures, with bone density T-score below − 2.5 as an independent inclusion criterion, inadequate medication response, and no prior surgical treatment who were treated at the neurosurgery outpatient department of a regional hospital in central Taiwan from June 2022 to October 2022. The experimental group received customized educational tools including a multimedia video, detailed leaflets, and a spinal model demonstration. In contrast, the control group’s education was limited to colorful graphic leaflets. Three scales for outcome measurement were used: the Disease Care Awareness Scale, the Shared Decision-Making Effectiveness Scale, and the Shared Decision-Making Satisfaction Scale.</p> Results <p>A total of 128 participants were included (control group: 64; experimental group: 64). Significant post-intervention improvements were observed in the experimental group for disease awareness (pre-intervention mean: 6.11, post-intervention mean: 9.03, <i>p</i> &lt; 0.001), shared decision-making effectiveness (pre-intervention mean: 30.06, post-intervention mean: 40.88, <i>p</i> &lt; 0.001), and medical satisfaction (pre-intervention mean: 19.81, post-intervention mean: 27.70, <i>p</i> &lt; 0.001). The control group showed significant improvement only in shared decision-making effectiveness.</p> Conclusions <p>Although customized educational tools show significant improvements in disease awareness, shared decision-making effectiveness, and medical satisfaction, these findings are based on within-group comparisons and should be interpreted with caution. Tailored health education may have the potential to improve patient outcomes in osteoporosis care.</p>