title: International Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates.
abstract: Adherence to oral bisphosphonates is low. A screening strategy is proposed based on the response of biochemical markers of bone turnover after 3 months of therapy. If no change is observed, the clinician should reassess the adherence to the treatment and also other potential issues with the drug.
  
  
  
  Low adherence to oral bisphosphonates is a common problem that jeopardizes the efficacy of treatment of osteoporosis. No clear screening strategy for the assessment of compliance is widely accepted in these patients.
  
  
  
  The International Osteoporosis Foundation and the European Calcified Tissue Society have convened a working group to propose a screening strategy to detect a lack of adherence to these drugs. The question to answer was whether the bone turnover markers (BTMs) PINP and CTX can be used to identify low adherence in patients with postmenopausal osteoporosis initiating oral bisphosphonates for osteoporosis. The findings of the TRIO study specifically address this question and were used as the basis for testing the hypothesis.
  
  
  
  Based on the findings of the TRIO study, specifically addressing this question, the working group recommends measuring PINP and CTX at baseline and 3 months after starting therapy to check for a decrease above the least significant change (decrease of more than 38% for PINP and 56% for CTX). Detection rate for the measurement of PINP is 84%, for CTX 87% and, if variation in at least one is considered when measuring both, the level of detection is 94.5%.
  
  
  
  If a significant decrease is observed, the treatment can continue, but if no decrease occurs, the clinician should reassess to identify problems with the treatment, mainly low adherence.
authors.affiliation: Department of Internal Medicine, Hospital del Mar-IMIM-Universitat Autònoma and CIBERFES-ISCIII, P Maritim 25-29, 08003, Barcelona, Spain. adiez@parcdesalutmar.cat.
authors.forename: A
authors.initials: A
authors.lastname: Diez-Perez
authors.affiliation: Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: Naylor
authors.affiliation: Institute of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark.|Department of Medicine, Holbæk Hospital, Holbæk, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Abrahamsen
authors.affiliation: Independent Scientific Consultant, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Agnusdei
authors.affiliation: Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Brandi
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.|NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, and CIBERFES-ISCIII, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.
authors.forename: E
authors.initials: E
authors.lastname: Dennison
authors.affiliation: Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway.
authors.forename: E F
authors.initials: EF
authors.lastname: Eriksen
authors.affiliation: Duke University Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
authors.forename: D T
authors.initials: DT
authors.lastname: Gold
authors.affiliation: Rheumatology Department, Hospital Clínic, University of Barcelona, CIBERehd, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Guañabens
authors.affiliation: Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Hadji
authors.affiliation: Department of Health Services Research, School for Public Health & Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hiligsmann
authors.affiliation: Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Horne
authors.affiliation: Department of Nutritional Sciences and Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Josse
authors.affiliation: Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Kanis
authors.affiliation: Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Obermayer-Pietsch
authors.affiliation: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
authors.forename: D
authors.initials: D
authors.lastname: Prieto-Alhambra
authors.affiliation: Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Reginster
authors.affiliation: Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: R
authors.initials: R
authors.lastname: Rizzoli
authors.affiliation: Cedars-Sinai/University of California, Los Angeles, USA.
authors.forename: S
authors.initials: S
authors.lastname: Silverman
authors.affiliation: Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: M C
authors.initials: MC
authors.lastname: Zillikens
authors.affiliation: Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
authors.forename: R
authors.initials: R
authors.lastname: Eastell
mesh_terms: D000284:Administration, Oral; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016723:Bone Remodeling / Q000502:physiology; D024042:Collagen Type I / Q000097:blood; D004164:Diphosphonates / Q000008:administration & dosage* / Q000627:therapeutic use; D004353:Drug Evaluation, Preclinical / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D055118:Medication Adherence; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D011347:Procollagen / Q000097:blood
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide
keywords: Adherence; Bisphosphonates; Osteoporosis treatment; Position paper; Screening