title: How the knowledge of fracture risk might influence adherence to oral therapy of osteoporosis in Italy: the ADEOST study.
abstract: The patients' adherence to osteoporosis treatments is low. In our study population a history of osteoporotic fractures was associated to better compliance and persistence; however, a 12-month randomized study carried out on 816 osteoporotic women showed that providing the patients with their individual fracture risk information did not prove effective.
  
  
  OBJECTIVE
  Several drugs are currently available for the treatment of osteoporosis, but the patients' compliance and persistence with these treatments are low. This study aimed to both analyze the adherence to oral osteoporosis medications among Italian osteoporotic patients (cross-sectional study) and evaluate if providing patients with their individual fracture risk information may improve compliance and persistence (prospective study).
  
  
  METHODS
  A total of 3379 osteoporotic patients referred as outpatients for a visit 1 year after receiving a prescription of oral osteoporosis medications for the first time, were enrolled for the retrospective study. Moreover, 816 postmenopausal women receiving an oral prescription for osteoporosis for the first time, were randomized into two groups: group 1 (managed according to standard clinical practice) and group 2 (managed with greater patient involvement and information on the individual risk of major osteoporotic fractures calculated by DeFRA algorithm).
  
  
  RESULTS
  In the retrospective study, a history of osteoporotic fractures, the frequency of drug administration and a condition of being overweight/obese had a significant influence on both compliance and persistence. Of the 816 patients enrolled in the longitudinal study, 731 (374 of group 1 and 357 of group 2) attended the 1 year follow-up visit. The percentage of women with high compliance or persistence was greater in group 2 (64.2 vs. 58.1 % and 66.8 vs. 62.6 %, respectively), but without reaching any statistical significance.
  
  
  CONCLUSIONS
  Although providing the patients with their individual fracture risk information was not statistically effective, further studies on additional interventions able to improve the patients' perceived risk of fracture are warranted.
authors.affiliation: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy. gonnelli@unisi.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gonnelli
authors.affiliation: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Caffarelli
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Rossi
authors.affiliation: Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Di Munno
authors.affiliation: Rheumatology, Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy.
authors.forename: Nazzarena
authors.initials: N
authors.lastname: Malavolta
authors.affiliation: Gerontology Section, Department of Medical Science, University of Torino, Turin, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Isaia
authors.affiliation: Department of Rheumatology, Hospital Galateo, San Cesario di Lecce, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muratore
authors.affiliation: Rheumatology Unit, AUSL 3, Catania, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: D'Avola
authors.affiliation: Department of Orthopedics and Traumatology, University of Salerno, Salerno, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gatto
authors.affiliation: Ospedale di Alta Specializzazione San Camillo, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Minisola
authors.affiliation: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci 2, 53100, Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
mesh_terms: D000284:Administration, Oral; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D012306:Risk
chemical_list: D050071:Bone Density Conservation Agents
keywords: Compliance; DeFRA; Fractures; Osteoporosis treatment; Persistence