Skip to main content
SpringerLink
Log in

A dedicated Fracture Liaison Service telephone program and use of bone turnover markers for evaluating 1-year persistence with oral bisphosphonates

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Telephone call intervention did not improve alendronate persistence in Fracture Liaison Service (FLS) patients in this study. A bone turnover marker cut-off point for alendronate persistence is proposed for individual FLS patients.

Introduction

FLS aims to prevent subsequent fractures, which should include improving patients’ persistence with prescribed oral bisphosphonates. We studied the influence of telephone calls and the predictive value of changes in bone turnover markers (BTMs) for evaluating persistence with alendronate.

Methods

Postmenopausal women with a recent fracture and osteoporosis who started alendronate were randomized to receive three phone calls (PC) (after 1, 4, and 12 months) or no phone calls (no PC). s-CTX and P1NP were measured at baseline and after 3, 6, 9, and 12 months. As a reference group, 30 postmenopausal osteopenic patients with a recent fracture were analyzed as well. Persistence was assessed using the Dutch National Switch Point Pharmacies-GPs database and cross-referenced with PC, no PC, and BTM changes. Cut-off values of BTMs were calculated based on least significant change (LSC) and also on underrunning median values of the untreated osteopenic postmenopausal reference group with a recent fracture.

Results

Out of 119 patients, 93 (78%) completed 12 months follow-up (45 PC and 48 no PC). Mean age was 69 years. Persistence was similar in PC and no PC participants. The cut-off value > 29% (< 415 ng/L) as LSC of s-CTX and > 36% (< 53.1 μg/L) as LSC of P1NP was determined optimally showing alendronate persistence after 1 year (being 93 and 88%, respectively).

Conclusions

In this context, telephone calls did not improve persistence. In around 90% of patients, 1-year alendronate persistence was confirmed by achieving LSC of s-CTX and of P1NP at 12 months.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 2012;27(10):2039–2046. doi: https://doi.org/10.1002/jbmr.1698.

  2. Lems WF, Dreinhöfer KE, Bischoff-Ferrari H, Blauth M, Czerwinski E, da Silva J, Herrera A, Hoffmeyer P, Kvien T, Maalouf G, Marsh D, Puget J, Puhl W, Poor G, Rasch L, Roux C, Schüler S, Seriolo B, Tarantino U, van Geel T, Woolf, Wyers C, Geusens P (2016. pii: annrheumdis-2016-210289) EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. https://doi.org/10.1136/annrheumdis-2016-210289

  3. Huntjens KM, van Geel TA, van den Bergh JP, van Helden S, Willems P, Winkens B, Eisman JA, Geusens PP, Brink PR. Fracture liaison service: impact on subsequent nonvertebral fracture incidence and mortality. J Bone Joint Surg Am 2014 19:96(4):e29. doi: https://doi.org/10.2106/JBJS.L.00223.

  4. Marsh D, Akesson K, Beaton DE, Bogoch ER, Boonen S, Brandi ML, McLellan AR, Mitchell PJ, Sale JE, Wahl DA, IOF CSA Fracture Working Group (2011) Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos Int 22(7):2051–2065. https://doi.org/10.1007/s00198-011-1642-x.

    Article  CAS  PubMed  Google Scholar 

  5. Svedbom A, Hernlund E, Ivergård M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jönsson B, Kanis JA (2013) The EU review panel of the IOF Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos 8(1-2):137. https://doi.org/10.1007/s11657-013-0137-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Akesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C (IOF Fracture Working Group). Capture the Fracture®: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int 2013 24(8):2135–2152. doi: https://doi.org/10.1007/s00198-013-2348-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24(2):393–406. https://doi.org/10.1007/s00198-012-2090-y

    Article  CAS  PubMed  Google Scholar 

  8. Mitchell PJ (2013) Best practices in secondary fracture prevention: Fracture Liaison Services. Curr Osteoporos Rep 11(1):52–60. https://doi.org/10.1007/s11914-012-0130-3

    Article  PubMed  Google Scholar 

  9. Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH, McLellan AR, Stenmark J, Pierroz DD, Schneider MC, Kanis JA, Akesson K, Cooper C, IOF Fracture Working Group; EXCO (2015 Nov) Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool. Osteoporos Int 26(11):2573–2578. https://doi.org/10.1007/s00198-015-3192-0.

    Article  CAS  PubMed  Google Scholar 

  10. van den Berg P, Schweitzer DH, van Haard PM, van den Bergh JP, Geusens PP (2015 Sep) Meeting international standards of secondary fracture prevention: a survey on Fracture Liaison Services in the Netherlands. Osteoporos Int 26(9):2257–2263. https://doi.org/10.1007/s00198-015-3117-y

    Article  PubMed  Google Scholar 

  11. Dutch Institute for Healthcare Improvement CBO (2011) Richtlijn Osteoporose en Fractuurpreventie. wwwdiliguidenl/document/1015/file/pdf/ (Dutch) Accessed 19 December 2015

  12. Netelenbos JC, Geusens PP, Ypma G, Buijs SJ (2011) Adherence and profile of non-persistence in patients treated for osteoporosis—a large-scale, long-term retrospective study in The Netherlands. Osteoporos Int 22(5):1537–1546. https://doi.org/10.1007/s00198-010-1372-5

    Article  CAS  PubMed  Google Scholar 

  13. Klop C, Welsing PM, Elders PJ, Overbeek JA, Souverein PC, Burden AM, van Onzenoort HA, Leufkens HG, Bijlsma JW, de Vries F (2015 Jun) Long-term persistence with anti-osteoporosis drugs after fracture. Osteoporos Int 26(6):1831–1840. https://doi.org/10.1007/s00198-015-3084-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Clowes JA, Peel NF, Eastell R (2004) The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomised controlled trial. J Clin Endocrinol Metab 89(3):1117–1123. https://doi.org/10.1210/jc.2003-030501

    Article  CAS  PubMed  Google Scholar 

  15. Schousboe JT, DeBold RC, Kuno LS, Weiss TW, Chen Y-T, Abbott TA III (2005) Education and phone follow-up in postmenopausal women at risk for osteoporosis: effects on calcium intake, exercise frequency, and medication use. Dis Manag Health Out 13(6):395–404. https://doi.org/10.2165/00115677-200513060-00004

    Article  Google Scholar 

  16. Cooper A, Drake J, Brankin E, Investigators PERSIST (2006) Treatment persistence with once-monthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study. Int J Clin Pract 60(8):896–905. https://doi.org/10.1111/j.1742-1241.2006.01059.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Delmas PD, Vrijens B, Eastell R, Roux C, Pols HA, Ringe JD, Grauer A, Cahall D, Watts NB, Improving Measurements of Persistence on Actonel Treatment (IMPACT) Investigators. Effect of monitoring bone turnover markers on persistence with risedronate treatment of postmenopausal osteoporosis. J Clin Endocrinol Metab 2007;92(4):1296–1304, DOI: https://doi.org/10.1210/jc.2006-1526, Effect of Monitoring Bone Turnover Markers on Persistence with Risedronate Treatment of Postmenopausal Osteoporosis.

  18. Cook PF, Emiliozzi S, McCabe MM (2007) Telephone counselling to improve osteoporosis treatment adherence: an effectiveness study in community practice settings. Am J Med Qual 22(6):445–456. https://doi.org/10.1177/1062860607307990

    Article  PubMed  Google Scholar 

  19. Shu AD1, Stedman MR, Polinski JM, Jan SA, Patel M, Truppo C, Breiner L, Chen YY, Weiss TW, Solomon DH. Adherence to osteoporosis medications after patient and physician brief education: post hoc analysis of a randomized controlled trial. Am J Manag Care 2009 Jul;15(7):417–424.

  20. Waalen J, Bruning AL, Peters MJ, Blau EM. A telephone-based intervention for increasing the use of osteoporosis medication: a randomized controlled trial. Am J Manag Care 2009;15(8):e60-e70.

  21. Solomon DH, Iversen MD, Avorn J, Gleeson T, Brookhart MA, Patrick AR, Rekedal L, Shrank WH, Lii J, Losina E, Katz JN (2012) Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial. Arch Intern Med 172(6):477–483. https://doi.org/10.1001/archinternmed.2011.1977

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tamone C, Fonte G, Panico A, Molinatti PA, D’Amelio P, Isaia GC (2012) Impact of a phone follow-up program on persistence with teriparatide or PTH(1-84) treatment. Calcif Tissue Int 90(4):272–278. https://doi.org/10.1007/s00223-012-9574-9

    Article  CAS  PubMed  Google Scholar 

  23. Stuurman-Bieze AG, Hiddink EG, van Boven JF, Vegter S (2014) Proactive pharmaceutical care interventions decrease patients’ nonadherence to osteoporosis medication. Osteoporos Int 25(6):1807–1812. https://doi.org/10.1007/s00198-014-2659-8

    CAS  PubMed  Google Scholar 

  24. Bianchi ML, Duca P, Vai S, Guglielmi G, Viti R, Battista C, Scillitani A, Muscarella S, Luisetto G, Camozzi V, Nuti R, Caffarelli C, Gonnelli S, Albanese C, De Tullio V, Isaia G, D'Amelio P, Broggi F, Croci M. Improving adherence to and persistence with oral therapy of osteoporosis. 2015 May;26(5):1629–38. doi: https://doi.org/10.1007/s00198-015-3038-9.

  25. Hiligsmann M, Salas M, Hughes DA, Manias E, Gwadry-Sridhar FH, Linck P, Cowell W (2013 Dec) Interventions to improve osteoporosis medication adherence and persistence: a systematic review and literature appraisal by the ISPOR Medication Adherence & Persistence Special Interest Group. Osteoporos Int 24(12):2907–2918. https://doi.org/10.1007/s00198-013-2364-z

    Article  CAS  PubMed  Google Scholar 

  26. Gleeson T, Iversen MD, Avorn J, Brookhart AM, Katz JN, Losina E, May F, Patrick AR, Shrank WH, Solomon DH (2009) Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review. Osteoporos Int 20(12):2127–2134. https://doi.org/10.1007/s00198-009-0976-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Genant HK, CY W, van Kuijk C, Nevitt MC (1993 Sep) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8(9):1137–1148. https://doi.org/10.1002/jbmr.5650080915

    Article  CAS  PubMed  Google Scholar 

  28. Arends S, Spoorenberg A, Bruyn GA, Houtman PM, Leijsma MK, Kallenberg CG, Brouwer E, van der Veer E (2011) The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis. Osteoporos Int 22(5):1431–1439. https://doi.org/10.1007/s00198-010-1338-7

    Article  CAS  PubMed  Google Scholar 

  29. https://www.vzvz.nl/uploaded/FILES/htmlcontent/Voorlichtingsmateriaal/Folder%20met%20toestemmingsformulier%20-%20Engels.pdf. Assessed February 2017.

  30. Diez-Perez A, Naylor KE, Abrahamsen B, Agnusdei D, Brandi ML, Cooper C, Dennison E, Eriksen EF, Gold DT, Guañabens N, Hadji P, Hiligsmann M, Horne R, Josse R, Kanis JA, Obermayer-Pietsch B, Prieto-Alhambra D, Reginster JY, Rizzoli R, Silverman S, Zillikens MC, Eastell R (2017) Adherence Working Group of the International Osteoporosis Foundation and the European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporos Int 28(3):767–774. https://doi.org/10.1007/s00198-017-3906-6Epub 2017 Jan 16

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Vasikaran S, Eastell R, Bruyère O, Foldes AJ, Garnero P, Griesmacher A, McClung M, Morris HA, Silverman S, Trenti T, Wahl DA, Cooper C, Kanis JA (2011) IOF-IFCC Bone Marker Standards Working Group. Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 22(2):391–420. https://doi.org/10.1007/s00198-010-1501-1 Epub 2010 Dec 24

    Article  CAS  PubMed  Google Scholar 

  32. Leys C, Ley C, Klein O, Bernard P, Licata L (2013) Detecting outliers: do not use standard deviation around the mean, use absolute deviation around the median. J Exp Soc Psychol 49(4):764–766. https://doi.org/10.1016/j.jesp.2013.03.013

    Article  Google Scholar 

  33. Eekman DA, Bultink IE, Heijboer AC, Dijkmans BA, Lems WF (2011) Bone turnover is adequately suppressed in osteoporotic patients treated with bisphosphonates in daily practice. BMC Musculoskelet Disord 12(1):167. https://doi.org/10.1186/1471-2474-12-167

    Article  PubMed  PubMed Central  Google Scholar 

  34. Naylor KE, Jacques RM, Paggiosi M, Gossiel F, Peel NF, McCloskey EV, Walsh JS, Eastell R (2016 Jan) Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study. Osteoporos Int 27(1):21–31. https://doi.org/10.1007/s00198-015-3145-

    Article  CAS  PubMed  Google Scholar 

  35. Sabaté E. Adherence to long-term therapies. Evidence for action. Geneva: World Health Organization, 2003 http://www.who.int/chp/knowledge/publications/adherence_report/en/. Published 2003. Accessed December 2015.

  36. Ganda K, Schaffer A, Pearson S, Seibel MJ (2014 Apr) 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. Osteoporos Int 25(4):1345–1355. https://doi.org/10.1007/s00198-013-2610-4

    Article  CAS  PubMed  Google Scholar 

  37. Jacob L, Dreher M, Kostev K, Hadji P (2016) Increased treatment persistence and its determinants in women with osteoporosis with prior fracture compared to those without fracture. Osteoporos Int 27(3):963–969. https://doi.org/10.1007/s00198-015-3378-5

    Article  CAS  PubMed  Google Scholar 

  38. Wölfl C, Schweppenhäuser D, Gühring T, Takur C, Höner B, Kneser U, Grützner PA, Kolios L (2014) Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low bone mineral density (BMD). PLoS One 9(5):e96058. https://doi.org/10.1371/journal.pone.0096058. eCollection 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ivaska KK, Gerdhem P, Akesson K, Garnero P, Obrant KJ (2007) Effect of fracture on bone turnover markers: a longitudinal study comparing marker levels before and after injury in 113 elderly women. J Bone Miner Res 22(8):1155–1164

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Lisette van Hulst for her critical linguistic advice, to Wil Aarssen, Erica Smit, and Tina Polko for their excellent secretarial services, to Luc Huijskes for his support with programming the study database, and to Hannette Kamminga at the UMCG Laboratory.

Funding

This study was funded by an unrestricted grant of Novartis.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Surgery, Fracture Liaison Service, Reinier de Graaf Gasthuis, Delft, the Netherlands

    P. van den Berg

  2. Department of Medical Laboratories, Association of Clinical Chemistry, Reinier the Graaf Gasthuis, Delft, the Netherlands

    P. M. M. van Haard

  3. Laboratory Medicine, University Medical Centre, Groningen, the Netherlands

    E. van der Veer

  4. Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands

    P. P. Geusens & J. P. van den Bergh

  5. Hasselt University, Hasselt, Belgium

    P. P. Geusens

  6. Department of Internal Medicine, VieCuri Medical Centre Noord-Limburg, Maastricht University Medical Center, Maastricht, the Netherlands

    J. P. van den Bergh

  7. Department of Internal Medicine and Endocrinology, Reinier the Graaf Gasthuis, Delft, the Netherlands

    D. H. Schweitzer

Authors
  1. P. van den Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. M. M. van Haard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. van der Veer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. P. Geusens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. P. van den Bergh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. H. Schweitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. van den Berg.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van den Berg, P., van Haard, P.M.M., van der Veer, E. et al. A dedicated Fracture Liaison Service telephone program and use of bone turnover markers for evaluating 1-year persistence with oral bisphosphonates. Osteoporos Int 29, 813–824 (2018). https://doi.org/10.1007/s00198-017-4340-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-017-4340-5

Keywords

Search

Navigation