trials to date suggest potential for improving persistence with medication taking thus improving treatment outcomes and reducing fracture risk .
More precise measurement of medication taking and promoting fidelity to a precisely defined intervention protocol may lead to better assessment of impact on clinical ly important outcomes
BACKGROUND despite availability of effective treatments for osteoporosis , impact on fracture rates may be suboptimal because of failure to adhere to recommended anti-resorptive therapy .
OBJECTIVE to identify r and omized controlled trials ( RCTs ) evaluating interventions intended to improve persistence with anti-resorptive therapy for treating women with osteoporosis or osteopenia .
Studies of the oral bioavailability of alendronate
Clinical studies were performed to examine the oral bioavailability of alendronate ( 4‐amino‐1‐hydroxybutylidene‐1,1‐bisphosphonate monosodium ) . All studies , with the exception of one performed in men , involved postmenopausal women . Short‐term ( 24 to 36 hours ) urinary recovery of alendronate after an intravenous dose of 125 to 250 μg averaged about 40 % in both men and women . In  women , oral bioavailability of  alendronate  was independent of dose ( 5 to 80 mg ) and averaged ( 90 % confidence interval ) 0.76 % ( 0.58 , 0.98 ) when taken with water in the fasting state , followed by a meal 2 hours later . Bioavailability was similar in men [ 0.59 % , ( 0.43 , 0.81 ) ] . Taking alendronate either 60 or 30 minutes before a st and ardized breakfast reduced bioavailability by 40 % relative to the 2‐hour wait . Taking alendronate either concurrently with or 2 hours after breakfast drastically ( > 85 % ) impaired availability . Black coffee or orange juice alone , when taken with the drug , also reduced bioavailability ( approximately 60 % ) . Increasing gastric pH , by infusion of ranitidine , was associated with a doubling of alendronate bioavailability . A practical dosing recommendation , derived from these findings and reflective of the long‐term nature of therapy for a disease such as osteoporosis , is that patients take the drug with water after an overnight fast and at least 30 minutes before any other food or beverage
trials to date suggest potential for improving persistence with medication taking thus improving treatment outcomes and reducing fracture risk .
More precise measurement of medication taking and promoting fidelity to a precisely defined intervention protocol may lead to better assessment of impact on clinical ly important outcomes
BACKGROUND despite availability of effective treatments for osteoporosis , impact on fracture rates may be suboptimal because of failure to adhere to recommended anti-resorptive therapy .
OBJECTIVE to identify r and omized controlled trials ( RCTs ) evaluating interventions intended to improve persistence with anti-resorptive therapy for treating women with osteoporosis or osteopenia .