title: Improving adherence to and persistence with oral therapy of osteoporosis.
abstract: Osteoporosis treatment has low adherence and persistence. This study evaluated if greater patient involvement could improve them. At 12 months, only 114 out of 344 participants were "fully adherent and persistent" (all drug doses taken throughout the study). Only frequency of drug administration had a significant influence on adherence.
  
  
  BACKGROUND
  Osteoporosis affects millions of individuals worldwide. There are now several effective drugs, but adherence to and persistence with treatment are low. This 12-month multicenter, prospective, randomized study evaluated the efficacy of two different methods aimed at improving adherence and persistence through greater patient involvement, compared with standard clinical practice.
  
  
  METHODS
  Three hundred thirty-four post-menopausal women, receiving an oral prescription for osteoporosis for the first time, were recruited and randomized into three groups: group 1 (controls, managed according to standard clinical practice) and groups 2 and 3 (managed with greater patient and caregiver involvement and special reinforcements: group 2, instructed to use several different "reminders"; group 3, same "reminders" as group 2, plus regular phone calls from and meetings at the referring Center). All enrolled women had two visits (baseline and 12 months).
  
  
  RESULTS
  Of 334 enrolled women, 247 (74%) started the prescribed therapy. Of those who started, 219 (88.7%) persisted in therapy for at least 10 months. At final evaluation, only 114 women were considered as "fully adherent and persistent" (all doses taken throughout the 12 months). There were no significant differences regarding "full adherence" among the three randomized groups. The frequency of drug administration had a significant influence: weekly administration had a >5-fold higher adherence and monthly administration an 8-fold higher adherence (p < 0.0001) than daily administration.
  
  
  CONCLUSIONS
  The special effort of devising and providing additional reminders did not prove effective. Additional interventions during the follow-up, including costly interventions such as phone calls and educational meetings, did not provide significant advantages.
authors.affiliation: Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, Via L. Ariosto 13, 20145, Milano, Italy, ml.bianchi@auxologico.it.
authors.forename: M L
authors.initials: ML
authors.lastname: Bianchi
authors.forename: P
authors.initials: P
authors.lastname: Duca
authors.forename: S
authors.initials: S
authors.lastname: Vai
authors.forename: G
authors.initials: G
authors.lastname: Guglielmi
authors.forename: R
authors.initials: R
authors.lastname: Viti
authors.forename: C
authors.initials: C
authors.lastname: Battista
authors.forename: A
authors.initials: A
authors.lastname: Scillitani
authors.forename: S
authors.initials: S
authors.lastname: Muscarella
authors.forename: G
authors.initials: G
authors.lastname: Luisetto
authors.forename: V
authors.initials: V
authors.lastname: Camozzi
authors.forename: R
authors.initials: R
authors.lastname: Nuti
authors.forename: C
authors.initials: C
authors.lastname: Caffarelli
authors.forename: S
authors.initials: S
authors.lastname: Gonnelli
authors.forename: C
authors.initials: C
authors.lastname: Albanese
authors.forename: V
authors.initials: V
authors.lastname: De Tullio
authors.forename: G
authors.initials: G
authors.lastname: Isaia
authors.forename: P
authors.initials: P
authors.lastname: D'Amelio
authors.forename: F
authors.initials: F
authors.lastname: Broggi
authors.forename: M
authors.initials: M
authors.lastname: Croci
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007558:Italy; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation; D011446:Prospective Studies; D013689:Telephone; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents