Adherence to oral bisphosphonates is low. A screening strategy is proposed based on the response of biochemical markers of bone turnover after 3 months of therapy. If no change is observed, the clinician should reassess the adherence to the treatment and also other potential issues with the drug.
Low adherence to oral bisphosphonates is a common problem that jeopardizes the efficacy of treatment of osteoporosis. No clear screening strategy for the assessment of compliance is widely accepted in these patients.
The International Osteoporosis Foundation and the European Calcified Tissue Society have convened a working group to propose a screening strategy to detect a lack of adherence to these drugs. The question to answer was whether the bone turnover markers (BTMs) PINP and CTX can be used to identify low adherence in patients with postmenopausal osteoporosis initiating oral bisphosphonates for osteoporosis. The findings of the TRIO study specifically address this question and were used as the basis for testing the hypothesis.
Based on the findings of the TRIO study, specifically addressing this question, the working group recommends measuring PINP and CTX at baseline and 3 months after starting therapy to check for a decrease above the least significant change (decrease of more than 38% for PINP and 56% for CTX). Detection rate for the measurement of PINP is 84%, for CTX 87% and, if variation in at least one is considered when measuring both, the level of detection is 94.5%.
If a significant decrease is observed, the treatment can continue, but if no decrease occurs, the clinician should reassess to identify problems with the treatment, mainly low adherence.
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Conflict of interest
A Diez-Perez is speaker or advisor for Amgen, Lilly, Merck, UCB, and Active Life Sci. Bo Abrahamsen reports current institutional research grants and contracts with Novartis and UCB, past institutional research contracts with Amgen, and NPS Pharmaceuticals. D. Agnusdei has a consultancy contract with Eli Lilly. Erik F Eriksen is a speaker and advisor for Amgen, Lilly, Merck, IDS, and Shire. Núria Guañabens is speaker or advisor for Amgen, Lilly, and Alexion Pharmaceuticals. Robert Josse is medical advisory board member and speaker honoraria and research grant: Merck, Amgen, Lilly. Daniel Prieto-Alhambra’s research group has received unrestricted grants from AMGEN S.A. Jean-Yves Reginster has consulting fees or paid advisory boards in Servier, Novartis, Negma, Lilly, Wyeth, Amgen, GlaxoSmithKline, Roche, Merckle, Nycomed-Takeda, NPS, IBSA-Genevrier, Theramex, UCB, Asahi Kasei, Endocyte, and Radius Health, and also has lecture fees when speaking at the invitation of the commercial sponsors: Merck Sharp and Dohme, Lilly, Rottapharm, IBSA, Genevrier, Novartis, Servier, Roche, GlaxoSmithKline, Merckle, Teijin, Teva, Analis, Theramex, Nycomed, NovoNordisk, Ebewee Pharma, Zodiac, Danone, Will Pharma, Amgen, and PharmEvo. He has grant support from the industry as follows: Bristol Myers Squibb, Merck Sharp & Dohme, Rottapharm, Teva, Roche, Amgen, Lilly, Novartis, GlaxoSmithKline, Servier, Pfizer, Theramex, Danone, Organon, Therabel, Boehringer, Chiltern, and Galapagos. M. Carola Zillikens has received fee for speaking and advice from Amgen, Eli Lilly, and MSD. R. Eastell has consulting fees from Amgen, AstraZeneca, Chronos, GSK, Immunodiagnostic Systems, Fonterra Brands, Ono Pharma, Lilly, Bayer, Janssen Research, Alere, CL Biosystems, Teijin Pharm, D-Star, Roche Diagnostics, and Inverness Medical; grant support from Amgen, Alexion, Immunodiagnostic Systems, Roche, and AstraZeneca. Kim E Naylor, Maria Luisa Brandi, Cyrus Cooper, Elaine Dennison, Deborah Gold, Peyman Hadji, Mickael Hiligsmann, Robert Horne, John A Kanis, Barbara Obermayer-Pietsch, René Rizzoli, and Stuart Silverman have no conflict of interest.
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Diez-Perez, A., Naylor, K.E., Abrahamsen, B. et al. International Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporos Int 28, 767–774 (2017). https://doi.org/10.1007/s00198-017-3906-6
- Osteoporosis treatment
- Position paper