Adherence to osteoporosis therapy after an upper extremity fracture: a pre-specified substudy of the C-STOP randomized controlled trial
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Despite their proven efficacy for secondary fracture prevention, long-term adherence with oral bisphosphonates is poor.
To compare the effectiveness of two interventions on long-term oral bisphosphonate adherence after an upper extremity fragility fracture.
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.
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.
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.
KeywordsAdherence C-STOP Osteoporosis
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.
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.
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