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 .
Effect of monitoring bone turnover markers on persistence with risedronate treatment of postmenopausal osteoporosis.
CONTEXT Persistence with osteoporosis treatment is poor but is important for maximum benefit . OBJECTIVE The objective of the study was to assess the impact of physician reinforcement using bone turnover markers ( BTMs ) on persistence with risedronate treatment . DESIGN AND SETTING This was a 1-yr multinational prospect i ve , open-label , blinded study in 171 osteoporosis centers in 21 countries . PATIENTS A total of 2382 postmenopausal women ( 65 - 80 yr old ) with spine/hip T-score -2.5 or less or T-score -1.0 or less with a low-trauma fracture . INTERVENTION Intervention included calcium 500 mg/d , vitamin D 400 IU/d , and risedronate 5 mg/d for 1 yr . Centers were r and omized to reinforcement ( RE+ ) or no reinforcement ( RE- ) . At 13 and 25 wk , reinforcement based on urinary N-telopeptide of type I collagen change from baseline was provided to the RE+ patients using the following response categories : good ( > 30 % decrease ) , stable ( -30 % to + 30 % change ) , or poor ( > 30 % increase ) . MAIN OUTCOME MEASURES Persistence assessed with electronic drug monitors was measured . RESULTS In the overall efficacy population ( n=2302 ) , persistence was unexpectedly high and was similar for both groups ( RE- , 77 % ; RE+ , 80 % ; P=0.160 ) . A significant relationship between the type of message and persistence was observed ( P=0.017 ) . Compared with RE- , intervention based on a good BTM response was associated with a significant improvement in persistence [ hazard ratio ( HR ) 0.71 ; 95 % confidence interval ( CI ) 0.53 - 0.95 ] . Persistence was unchanged ( HR 1.02 ; 95 % CI 0.74 - 1.40 ) or lower ( HR 2.22 ; 95 % CI 1.27 - 3.89 ) when reinforcement was based on a stable or poor BTM response , respectively . Reinforcement was associated with a lower incidence of new radiologically determined vertebral fractures ( odds ratio 0.4 ; 95 % CI , 0.2 - 1.0 ) . CONCLUSIONS Reinforcement using BTMs influences persistence with treatment in postmenopausal women with osteoporosis , depending on the BTM response observed
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 .