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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.

Author information

1
Department of Medicine, University of Alberta, Edmonton, Canada. Finlay.McAlister@ualberta.ca.
2
Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta, T6G 2G3, Canada. Finlay.McAlister@ualberta.ca.
3
Department of Medicine, University of Alberta, Edmonton, Canada.
4
Department of Physical Therapy, University of Alberta, Edmonton, Canada.
5
Department of Emergency Medicine, University of Alberta, Edmonton, Canada.
6
School of Public Health, University of Alberta, Edmonton, Canada.
7
EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Canada.

Abstract

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

INTRODUCTION:

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

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

TRIAL REGISTRATION:

ClinicalTrials.gov : NCT01401556.

KEYWORDS:

Adherence; C-STOP; Osteoporosis

PMID:
30232538
DOI:
10.1007/s00198-018-4702-7

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