Impact of the Training on the Compliance and Persistence of Weekly Bisphosphonate Treatment in Postmenopausal Osteoporosis: A Randomized Controlled Study

Abstract

Long-term patient adherence to osteoporosis treatment is poor despite proven efficacy. In this study, we aimed to assess the impact of active patient training on treatment compliance and persistence in patients with postmenopausal osteoporosis. In the present national, multicenter, randomized controlled study, postmenopausal osteoporosis patients (45-75 years) who were on weekly bisphosphonate treatment were randomized to active training (AT) and passive training (PT) groups and followed-up by 4 visits after the initial visit at 3 months interval during 12 months of the treatment. Both groups received a bisphosphonate usage guide and osteoporosis training booklets. Additionally, AT group received four phone calls (at 2nd, 5th, 8th, and 11th months) and participated to four interactive social/training meetings held in groups of 10 patients (at 3rd, 6th, 9th, and 12th months). The primary evaluation criteria were self-reported persistence and compliance to the treatment and the secondary evaluation criteria was quality life of the patients assessed by 41-item Quality of Life European Foundation for Osteoporosis (QUALEFFO-41) questionnaire.. Of 448 patients (mean age 62.4±7.7 years), 226 were randomized to AT group and 222 were randomized to PT group. Among the study visits, the most common reason for not receiving treatment regularly was forgetfulness (54.9% for visit 2, 44.3% for visit 3, 51.6% for visit 4, and 43.8% for visit 5), the majority of the patients always used their drugs regularly on recommended days and dosages (63.8% for visit 2, 60.9% for visit 3, 72.1% for visit 4, and 70.8% for visit 5), and most of the patients were highly satisfied with the treatment (63.4% for visit 2, 68.9% for visit 3, 72.4% for visit 4, and 65.2% for visit 5) and wanted to continue to the treatment (96.5% for visit 2, 96.5% for visit 3, 96.9% for visit 4, and 94.4% for visit 5). QUALEFFO scores of the patients in visit 1 significantly improved in visit 5 (37.7±25.4 vs. 34.0±14.6, p<0.001); however, the difference was not significant between AT and PT groups both in visit 1 and visit 5. In conclusion, in addition to active training, passive training provided at the 1st visit did not improve the persistence and compliance of the patients for bisphosphonate treatment.

Anti-osteoporotic activity of puerarin 6″-O-xyloside on ovariectomized mice and its potential mechanism

“…It is estimated that about 30% of postmenopausal women in the USA and Europe have osteoporosis, and osteoporosis is one of the major health problems of elderly women (Bock & Felsenberg, 2008;Tüzün et al, 2013). Osteoporosis is associated with ovarian hormone deficiency following menopause, and is the most common cause of age-related bone loss (Nian & Qin, 2006;Riggs & Melton, 1986).…”

Celastrol inhibits glucocorticoid‑induced osteoporosis in rat via the PI3K/AKT and Wnt signaling pathways

“…GIOP, glucocorticoid-induced osteoporosis model group; PGE-2, prostaglandin E2. deficiency-induced bone loss is believed to be the primary cause of elderly osteoporosis (15). To the best of our knowledge the present study may provide the first evidence in examining whether Celastrol inhibits body weight, osteoporosis and PGE-2 and caspase-3 protein expression levels in GIOP mice.…”

Interventions to improve adherence to anti-osteoporosis medications: an updated systematic review

“…Ninety-five percent of patients came from two studies [ 24 , 35 ]. The majority of patients were female, and eight studies included solely females [ 22 , 25 – 28 , 30 , 32 ]. Seven studies were European [ 22 , 26 , 27 , 30 – 33 ], five studies North-American [ 24 , 25 , 29 , 34 , 35 ], two from Australia [ 21 , 28 ], and one from Japan [ 23 ].…”

“…Other interventions were conducted by trained coordinators ( n = 1) [ 35 ], medical secretaries ( n = 1) [ 22 ], pharmacists ( n = 1) [ 33 ], or a combination of physicians and allied healthcare workers ( n = 1) [ 36 ]. Four studies did not report by whom the intervention was conducted [ 23 , 25 , 30 , 32 ].…”

“…Implementation was described as medication possession rate (MPR) ≥ 80% [ 21 , 22 , 28 , 33 , 35 ], a medication possession rate (MPR) ≥ 50% [ 32 , 35 ], per the instructions of the physician at regular intervals and dosages [ 30 ], the percentage of the prescribed dose taken [ 27 ], scoring ≥ 75% on the Morisky Medication Adherence Scale (MMAS) [ 31 ], self-report of current osteoporosis medication use at 6 months [ 25 ], or active treatment 12 months after initiation [ 34 ]. Discontinuation was described as continuing to receive treatment over the long term [ 30 ], as permanently stopping anti-osteoporosis medication [ 33 ], continuation of treatment after 26 weeks [ 32 ], or continuing of medication after 1 year [ 22 ]. Persistence was mentioned as an outcome in three studies [ 26 , 27 , 31 ].…”