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Osteoporos Int. 2018 Sep 19. doi: 10.1007/s00198-018-4702-7. [Epub ahead of print]

Adherence to osteoporosis therapy after an upper extremity fracture: a pre-specified substudy of the C-STOP randomized controlled trial.

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Department of Medicine, University of Alberta, Edmonton, Canada.
Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta, T6G 2G3, Canada.
Department of Medicine, University of Alberta, Edmonton, Canada.
Department of Physical Therapy, University of Alberta, Edmonton, Canada.
Department of Emergency Medicine, University of Alberta, Edmonton, Canada.
School of Public Health, University of Alberta, Edmonton, Canada.
EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Canada.


Despite their proven efficacy for secondary fracture prevention, long-term adherence with oral bisphosphonates is poor.


To compare the effectiveness of two interventions on long-term oral bisphosphonate adherence after an upper extremity fragility fracture.


Community-dwelling participants 50 years or older with upper extremity fragility fractures not previously treated with bisphosphonates were randomized to either a multi-faceted patient and physician educational intervention (the active control arm) vs. a nurse-led case manager (the study arm). Primary outcome was adherence (taking > 80% of prescribed doses) with prescribed oral bisphosphonates at 12 months postfracture between groups; secondary outcomes included rates of primary non-adherence and 24-month adherence. We also compared quality of life between adherent and non-adherent patients.


By 12 months, adherence with the initially prescribed bisphosphonate was similar (p = 0.96) in both groups: 38/48 (79.2%) in the educational intervention group vs. 66/83 (79.5%) in the case manager arm. By 24 months, adherence rates were 67% (32/48) in the educational intervention group vs. 53% (43/81) in case managed patients (p = 0.13). Primary non-adherence was 6% (11 patients) in the educational intervention group and 12% (21 patients) in the case managed group (p = 0.07). Prior family history of osteoporosis (aOR 2.1, 95% CI 1.0 to 4.4) and being satisfied with current medical care (aOR 2.3, 95% CI 1.1 to 4.8) were associated with better adherence while lower income (aOR 0.2, 95% CI 0.1 to 0.6, for patients with income < $30,000 per annum) was associated with poorer rates of adherence. There were no differences in health-related quality of life scores at baseline or during follow-up between patients who were adherent and those who were not.


While both interventions achieved higher oral bisphosphonate adherence compared to previously reported adherence rates in the general population, primary non-adherence and long-term adherence to bisphosphonates were similar in both arms. Adherence was influenced by family history of osteoporosis, satisfaction with current medical care, and income.



Adherence; C-STOP; Osteoporosis


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