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J Bone Metab. 2019 Feb;26(1):39-44. doi: 10.11005/jbm.2019.26.1.39. Epub 2019 Feb 28.

Impact on Bisphosphonate Persistence and Compliance: Daily Postprandial Administration.

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Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea.
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea.
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.



Bisphosphonate (BP) is an effective drug for the prevention and treatment of osteoporosis. However, gastrointestinal distress caused by BP is a well-known side effect for low compliance. The aim of our study was to compare the 1-year persistence, compliance and T-scores between the aperitif medication group and the postprandial medication group.


Three hundred patients were included in this study to determine their persistence and compliance with the prescribed daily BP (Maxmarvil®, alendronate 5 mg and calcitriol 0.5 µg; YuYu Pharm) following distal radius fractures. Patients in Group 1 (aperitif medication) were asked to adhere to the general guidelines for BPs before breakfast. Patients in Group 2 (postprandial medication) were recommended medication after breakfast. We compared the persistence and compliance of this daily BP therapy using the medication possession ratio (MPR) and T-scores between the 2 groups after 1 year.


Bone mineral density in hip and lumbar spine was improved significantly in 2 groups (P<0.001). Significant differences existed between 2 groups, including 73 of 150 patients (48.7%) in Group 1, and 111 of 150 patients (73.3%) in Group 2 for 1-year persistence (P=0.001). The mean MPR is 0.66 in Group 1 (range, 0.50-0.86) and 0.71 in Group 2 (range, 0.54-0.87). A significant difference was detected between the 2 groups (P=0.002).


Postprandial administration improved persistence and compliance with daily BP therapy, resulting in better clinical outcomes.


Aperitif; Bisphosphonate; Compliance; Daily; Persistence; Postprandial

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