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Osteoporosis International

Published in:

01-01-2019 | Original Article

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

Authors: F. A. McAlister, C. Ye, L. A. Beaupre, B. H. Rowe, J. A. Johnson, D. Bellerose, I. Hassan, S. R. Majumdar

Published in: Osteoporosis International | Issue 1/2019

Abstract

Summary

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

Osteoporosis Canada Guidelines. 2017. Available at https://osteoporosis.ca/health-care-professionals/clinical-practice-guidelines. Accessed 15-11-2017

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Title: Adherence to osteoporosis therapy after an upper extremity fracture: a pre-specified substudy of the C-STOP randomized controlled trial
Authors: F. A. McAlister
C. Ye
L. A. Beaupre
B. H. Rowe
J. A. Johnson
D. Bellerose
I. Hassan
S. R. Majumdar
Publication date: 01-01-2019
Publisher: Springer London
Published in: Osteoporosis International / Issue 1/2019
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-018-4702-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Summary

Introduction

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Trial registration

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