Compliance and persistence to oral bisphosphonate therapy following initiation within a secondary fracture prevention program: a randomised controlled trial of specialist vs. non-specialist management
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Following initiation of oral bisphosphonate therapy through a secondary fracture prevention program, 2-year treatment compliance and persistence remained high and were similar in patients randomised to follow-up by either the program or primary care physician. Thus, community-based and specialist management are equally effective in supporting compliance and persistence with anti-osteoporotic treatments.
The purpose of this study was to determine whether management by a secondary fracture prevention (SFP) program (aka “fracture liaison service”) results in better compliance and persistence to oral bisphosphonate therapy than follow-up by the primary care physician, after initiation within an SFP program.
This prospective RCT included 102 patients with incident osteoporotic fractures referred to a SFP program in Sydney, Australia. Following oral bisphosphonate therapy initiation, patients were randomised to either 6-monthly follow-up with the SFP program (group A) or referral to their primary care physician with a single SFP program visit at 24 months (group B). Compliance and persistence to treatment were measured using pharmaceutical claims data. Predictors of compliance and persistence and associations between compliance and persistence, and changes in bone mineral density (BMD) or bone resorption marker, urinary deoxypyridinoline over 24 months were analysed.
The median medication possession ratio at 24 months was 0.78 (IQR, 0.50–0.93) in group A and 0.79 (IQR, 0.48–0.96) in group B (p = 0.68). Persistence at 24 months was also similar in both groups (64 vs. 61 %, respectively; p = 0.75). After adjusting for confounders, patients in group A were not more likely to be compliant (OR, 1.06; 95 % CI, 0.46–2.47) or persistent (HR, 0.83; 95 % CI, 0.27–1.67) than those randomised to group B. Time-based changes in BMD or bone turnover were not associated with compliance or persistence.
Compliance and persistence to oral bisphosphonate therapy remain high amongst patients initiated within an SFP program, with community-based and SFP program management being equally effective in maintaining therapeutic compliance and persistence over 2 years. These results indicate that one of the main functions of an SFP program may be the initiation of therapy rather than continuous patient monitoring.
KeywordsCompliance Osteoporosis Persistence Pharmaceutical claims data Secondary fracture prevention program Treatment
We thank Kathy Wu, Anna Lih, Paul Lee, Veena Jayadev, Rohit Rajagopal, Damien Smith, Belinda Poon, Chris Muir, Bev White, Lynley Robinson and Klaus Sommer and his team for their invaluable contributions to data collection and entry. Thanks to Caroline Sullivan (coordinator and research assistant) and Fiona Blyth for reviewing the manuscript.
Conflicts of interest
Sallie Pearson is a Cancer Institute New South Wales Career Development Fellow 12/CDF/2-25.
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