Advertisement

Osteoporosis International

, Volume 30, Issue 1, pp 127–134 | Cite as

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

  • F. A. McAlisterEmail author
  • C. Ye
  • L. A. Beaupre
  • B. H. Rowe
  • J. A. Johnson
  • D. Bellerose
  • I. Hassan
  • S. R. Majumdar
Original Article
  • 125 Downloads

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

Keywords

Adherence C-STOP Osteoporosis 

Notes

Acknowledgements

We thank the local opinion leaders who helped prepare the actionable evidence summaries for this study: Drs. Stephanie Li, Matthew Menon, Brian Wirzba, Walter Maksymowych, and Anthony Russell.

Funding sources

This trial received funding from Alberta Innovates through a Partnership in Research and Innovation in the Healthcare System (PRIHS) grant. The funders take no responsibility for the conduct, results or opinions expressed in this manuscript.

Compliance with ethical standards

Conflicts of interest

None. SR Majumdar held the Endowed Research Chair in Patient Health Management supported by the Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences at the University of Alberta. LA Beaupre holds the David Magee Endowed Chair for Musculoskeletal Research at the University of Alberta. BH Rowe is supported by a Tier I Canada Research Chair in Evidence-Based Emergency Medicine from CIHR. FA McAlister is supported by the Alberta Health Services Chair in Cardiovascular Outcomes Research.

References

  1. 1.
    Osteoporosis Canada Guidelines. 2017. Available at https://osteoporosis.ca/health-care-professionals/clinical-practice-guidelines. Accessed 15-11-2017
  2. 2.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22:465–475CrossRefGoogle Scholar
  3. 3.
    Kanis JA, Johnell O, De LC et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382CrossRefGoogle Scholar
  4. 4.
    Langsetmo L, Goltzman D, Kovacs CS, Adachi JD, Hanley DA, Kreiger N, Josse R, Papaioannou A, Olszynski WP, Jamal SA, the CaMos Research Group (2009) Repeat low-trauma fractures occur frequently among men and women who have osteopenic BMD. J Bone Miner Res 24:1515–1522CrossRefGoogle Scholar
  5. 5.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. J Am Med Assoc 301:513–521CrossRefGoogle Scholar
  6. 6.
    Klop C, Welsing PM, Elders PJ et al (2015) Long-term persistence with anti-osteoporosis drugs after fracture. Osteoporos Int 26:1831–1840CrossRefGoogle Scholar
  7. 7.
    Armstrong PW, McAlister FA (2016) Searching for adherence: can we fulfill the promise of evidence based medicines? J Am Coll Cardiol 68:802–804CrossRefGoogle Scholar
  8. 8.
    Sokol M, McGuigan K, Verbrugge R et al (2005) Impact of medication adherence on hospitalization risk and healthcare cost. Med Care 43(6):521–530CrossRefGoogle Scholar
  9. 9.
    Majumdar SR, McAlister FA, Johnson JA, Rowe BH, Bellerose D, Hassam I, Lier DA, Li S, Maksymowych WP, Menon M, Russell AS, Wirzba B, Beaupre LA. Comparing strategies targeting osteoporosis to prevent recurrent fractures after an upper extremity fracture (C-STOP Trial): a randomized controlled trial. J Bone Miner Res 2018;(in press) Google Scholar
  10. 10.
    Halpern MT, Khan ZM, Schmier JK, Burnier M, Caro JJ, Cramer J, Daley WL, Gurwitz J, Hollenberg NK (2006) Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data. Hypertension 47:1039–1048CrossRefGoogle Scholar
  11. 11.
    Reynolds K, Muntner P, Cheetham TC et al (2014) Primary non-adherence to bisphosphonates in an integrated healthcare setting. Osteoporosis Int 24(9):2509–2517CrossRefGoogle Scholar
  12. 12.
    Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233CrossRefGoogle Scholar
  13. 13.
    Lydick E, Zimmerman SI, Yawn B, Love B, Kleerekoper M, Ross P, Martin A, Holmes R (1997) Development and validation of a discriminative quality of life questionnaire for osteoporosis (the OPTQoL). J Bone Miner Res 12:456–463CrossRefGoogle Scholar
  14. 14.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected] The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608CrossRefGoogle Scholar
  15. 15.
    Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778CrossRefGoogle Scholar
  16. 16.
    Leslie WD, LaBine L, Klassen P, Dreilich D, Caetano PA (2012) Closing the gap in postfracture care at the population level: a randomized controlled trial. Osteoporos Int 184:290–296Google Scholar
  17. 17.
    Cramer JA, Gold DT, Silverman SL, Lewiecki EM (2007) A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 18:1023–1031CrossRefGoogle Scholar
  18. 18.
    Ganda K, Schaffer A, Pearson S, Seibel MJ (2014) 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. Osteoporosis Int 25:1345–1355CrossRefGoogle Scholar
  19. 19.
    Hussey PS, Schneider EC, Rudin RS, Fox DS, Lai J, Pollack CE (2014) Continuity and the costs of care for chronic disease. JAMA Intern Med 174(5):742–748CrossRefGoogle Scholar
  20. 20.
    Brookhart MA, Patrick AR, Schneeweiss S, Avorn J, Dormuth C, Shrank W, van Wijk B, Cadarette SM, Canning CF, Solomon DH (2007) Physician follow-up and provider continuity are associated with long-term medication adherence. A study of the dynamics of statin use. Arch Intern Med 167:847–852CrossRefGoogle Scholar
  21. 21.
    Feldstein AC, Weycker D, Nichols GA, Oster G, Rosales G, Boardman DL, Perrin N (2009) Effectiveness of bisphosphonate therapy in a community setting. Bone 44:153–159CrossRefGoogle Scholar
  22. 22.
    Cotte FE, Fautrel B, Pouvourville G (2009) A Markov model simulation of the effect of treatment persistence in postmenopausal osteoporosis. Med Decis Mak 29:125–139CrossRefGoogle Scholar
  23. 23.
    Keshishian A, Boytsov N, Burge R, Krohn K, Lombard L, Zhang X, Xie L, Baser O (2017) Examining the effect of medication adherence on risk of subsequent fracture among women with a fragility fracture in the U.S. Medicare population. J Manag Care Spec Pharm 23(11):1178–1190Google Scholar
  24. 24.
    Nieuwlaat R, Wilczynski N, Navarro T et al (2014 Nov 20) Interventions for enhancing medication adherence. Cochrane Database Syst Rev 11:CD000011Google Scholar
  25. 25.
    T1 G, Iversen MD, Avorn J et al (2009) Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review. Osteoporos Int 20(12):2127–2134Google Scholar
  26. 26.
    Przemyslaw P, Pawel L, Michal M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol 2013;4(91)Google Scholar
  27. 27.
    Wozniak LA, Johnson JA, McAlister FA et al (2017) Understanding fragility fracture patients decision-making process regarding bisphosphonate treatment. Osteoporos Int 28:219–229CrossRefGoogle Scholar
  28. 28.
    Vieira HP, Leite IA, Araújo Sampaio TM, dos Anjos de Paula J, do Nascimento Andrade A, de Abreu L, Valenti VE, Goulart FC, Adami F (2013) Bisphosphonates adherence for treatment of osteoporosis. Int Arch Med 6:24CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  1. 1.Department of MedicineUniversity of AlbertaEdmontonCanada
  2. 2.Clinical Sciences BuildingUniversity of AlbertaEdmontonCanada
  3. 3.Department of Physical TherapyUniversity of AlbertaEdmontonCanada
  4. 4.Department of Emergency MedicineUniversity of AlbertaEdmontonCanada
  5. 5.School of Public HealthUniversity of AlbertaEdmontonCanada
  6. 6.EPICORE Centre, Department of MedicineUniversity of AlbertaEdmontonCanada

Personalised recommendations