title: Monitoring of bone turnover markers does not improve persistence with ibandronate treatment.
abstract: OBJECTIVE
  To assess if the use of biological marker of bone resorption (CTX) feedback is a mean to improve persistence on monthly oral ibandronate.
  
  
  METHODS
  One year prospective multicenter study using a cluster randomisation design with physicians as randomized units into two groups, A and B; in group B, physicians used results of CTX and two standardized messages according to CTX changes from baseline: suboptimal if decrease less than 30% at week 6, positive otherwise. In group A, the follow-up was standard of care. Patients were postmenopausal women, initiating a treatment with ibandronate 150 mg monthly. They were blinded to the study hypotheses and outcome. The outcome was the proportion of patients persistent at 1-year visit.
  
  
  RESULTS
  Eighty-eight physicians were randomized in group A and included 346 patients, 75 in group B included 250 patients. The persistence at 1-year was high and not different between the two groups (75.1 and 74.8% P=0.932). There was no difference in the proportion of persistent patients according to the message delivered in the group of patient with CTX information: 77.4 and 74.8% in patients with a suboptimal or positive message respectively.
  
  
  CONCLUSIONS
  This study failed to demonstrate that supporting monitoring of CTX could improve persistence to ibandronate treatment in postmenopausal osteoporosis.
  
  
  CONCLUSIONS
  Persistence is a strong determinant of anti-osteoporotic treatments efficacy. Monitoring of bone markers is not a mean to improve persistence of an oral bisphosphonate. There is a discrepancy between levels of persistence in clinical studies and real life.
authors.affiliation: Service de rhumatologie, Paris Descartes University, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France. christian.roux@cch.aphp.fr
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.forename: Bruno
authors.initials: B
authors.lastname: Giraudeau
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Rouanet
authors.forename: Geneviève
authors.initials: G
authors.lastname: Dubourg
authors.forename: Elodie
authors.initials: E
authors.lastname: Perrodeau
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
mesh_terms: D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001862:Bone Resorption / Q000097:blood / Q000188:drug therapy*; D024042:Collagen Type I / Q000097:blood; D004164:Diphosphonates / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D000077557:Ibandronic Acid; D008297:Male; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D000077557:Ibandronic Acid