Impact of pharmaceutical care on knowledge, quality of life and satisfaction of postmenopausal women with osteoporosis Tailored Interventions to Enhance Osteoporosis Prevention in Women Design of the POSSIBLE US™ Study: postmenopausal women’s compliance and persistence with osteoporosis medications Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: a randomized controlled trial. Improving adherence to and persistence with oral therapy of osteoporosis Prevention of osteoporosis as a consequence of aromatase inhibitor therapy in postmenopausal women with early breast cancer: rationale and design of a randomized controlled trial. The impact of osteoporosis medication beliefs and side-effect experiences on non-adherence to oral bisphosphonates* Proactive pharmaceutical care interventions decrease patients’ nonadherence to osteoporosis medication Effects of pharmaceutical care on adherence and persistence to bisphosphonates in postmenopausal osteoporotic women. Protocol for the Osteoporosis Choice trial. A pilot randomized trial of a decision aid in primary care practice A randomized controlled trial of mailed osteoporosis education to older adults Community pharmacist-initiated screening program for osteoporosis: randomized controlled trial Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial. Patient-reported reasons for nonadherence to recommended osteoporosis pharmacotherapy. First Indian prospective randomized comparative study evaluating adherence and compliance of postmenopausal osteoporotic patients for daily alendronate, weekly risedronate and monthly ibandronate regimens of bisphosphonates Telephone Counseling to Improve Osteoporosis Treatment Adherence: An Effectiveness Study in Community Practice Settings Compliance and treatment satisfaction of post menopausal women treated for osteoporosis. Compliance with osteoporosis treatment
Background This study describes the analysis of secondary outcomes from a previously published r and omised controlled trial , which assessed the effects of pharmaceutical care on medication adherence , persistence and bone turnover markers . The main focus of this manuscript is the effect of the provision of pharmaceutical care on these secondary outcomes , and details on the design of the intervention provided , the osteoporosis care plan and material s used to deliver the intervention . Objectives To evaluate the effects of pharmaceutical care on knowledge , quality of life ( QOL ) and satisfaction of postmenopausal osteoporotic women prescribed bisphosphonates , and their associating factors . Setting R and omised controlled trial , performed at an osteoporosis clinic of a tertiary hospital in Malaysia . Methods Postmenopausal women diagnosed with osteoporosis ( T-score ≤−2.5/lowtrauma fracture ) , just been prescribed weekly alendronate/risedronate  were r and omly allocated to receive intervention or st and ard care ( controls ) . Intervention participants received a medication review , education on osteoporosis , risk factors , lifestyle modifications , goals of therapy , side effects and the importance of medication adherence at months 0 , 3 , 6 and 12 . Main outcomes measure Knowledge , QOL and satisfaction . Results A total of 198 postmenopausal osteoporotic women were recruited : intervention = 100 and control = 98 . Intervention participants reported significantly higher knowledge scores at months 3 ( 72.50 vs. 62.50 % ) , 6 ( 75.00 vs. 65.00 % ) and 12 ( 78.75 vs. 68.75 % ) compared to control participants . QOL scores were also lower ( which indicates better QOL ) at months 3 ( 29.33 vs. 38.41 ) , 6 ( 27.50 vs. 36.56 ) and 12 ( 27.53 vs. 37.56 ) compared to control participants . Similarly , satisfaction score was higher in intervention participants ( 93.67 vs. 84.83 % ) . More educated women , with back pain , who were provided pharmaceutical care had better knowledge levels . Similarly , older , more educated women , with previous falls and back pain tend to have poorer QOL , whilst women who exercised more frequently and were provided pharmaceutical care had better QOL . Satisfaction also increased as QOL increases and when provided pharmaceutical care . Conclusion The provision of pharmaceutical care improved knowledge , QOL and satisfaction in Malaysian postmenopausal osteoporotic women , showing that pharmacists have the potential to improve patients ’ overall bone health . Policymakers should consider placing a clinical pharmacist in the osteoporosis clinic to provide counselling to improve these outcomes PURPOSE The purpose of this pilot study was to determine if tailored nursing interventions based on personal knowledge of bone mineral density from a dual-energy x-ray absorptiometry cause increases in knowledge of osteoporosis , health beliefs , or osteoporosis-prevention behaviors in postmenopausal women 50–65 years of age , 6 months after the intervention . METHOD The design for this pilot study was a two group quasi-experimental design . The treatment group received a tailored intervention ; the control group did not . Outcome data were gathered at 6 months after dual-energy x-ray absorptiometry . The tailored intervention was design ed and given to each woman via telephone using her dual-energy x-ray absorptiometry results and osteoporosis question naire data that addressed her knowledge of osteoporosis and osteoporosis-prevention behaviors of calcium intake , exercise , smoking , and alcohol use . A written mailed copy of the intervention followed the telephone interview . Six months after the intervention , the women were mailed another osteoporosis question naire to determine if the tailored intervention made a difference in the outcome variables . SAMPLE A total 124 women between the ages of 50 and 65 ( 101 control , 23 treatment ) comprised the sample . RESULTS There was no difference in knowledge between groups . On the average , there were significantly more perceived barriers to calcium in the tailored group ( mean = 13.48 ) than in the nontailored group ( mean = 11.55 ) ( t = 2.147 ; df = 122 ; p = .034 ) . There were significantly more perceived barriers to exercise in the tailored group ( mean = 14.39 ) than in the nontailored group ( mean = 12.21 ) ( t = .144 ; df = 122 ; p = .034 ) . Daily calcium intake increased in both the tailored and the nontailored groups . The tailored intervention increased women 's daily calcium intake from 614.28 to 1039.10 mg ( t = −2.896 ; df = 22 ; p = .008 ) . The nontailored group daily calcium intake increased from 587.91 to 916.30 mg ( t = −3.541 ; df = 100 ; p = .001 ) ; there was no significant difference between the groups . Weight-bearing exercise behaviors decreased from 96.04 minutes to 59.2 minutes in the tailored group but increased slightly in the nontailored group from 81.47 to 87.26 minutes of exercise . CONCLUSION Tailored interventions  increased women 's perceived barriers to calcium and exercise . Both groups increased calcium intake . The mixed findings of increased perception of barriers to calcium and exercise and decreased exercise behaviors indicate the need for further study . This important intervention has implication s for orthopaedic nurses and healthcare professionals involved in health promotion and prevention of osteoporosis Summary Failure to take prescribed medication is common . The POSSIBLE US ™ study is evaluating the impact of physician and patient characteristics on patient-reported compliance and persistence with osteoporosis medications . We report our study design and the baseline characteristics of 4,994 postmenopausal women recruited from primary care physician offices in 33 states . Introduction The Prospect i ve Observational Scientific Study Investigating Bone Loss Experience ( POSSIBLE US ™ ) is a longitudinal cohort study of osteoporosis therapy in primary care . Methods Between 2004 and 2007 , 134 physicians ( in 33 states ) enrolled postmenopausal women initiating , changing , or continuing osteoporosis medications .  After completing a baseline question naire , participants will provide data semi-annually for up to 3 years through 2008 . Physicians provide patient data at baseline and routine follow-up visits . Participants from 23 sites also signed a release regarding administrative cl aims data for economic analyses and validation of self-reported data .Baseline results Four thous and nine hundred and ninety-four evaluable women were recruited from internal medicine ( n = 1,784 ) , family practice ( n = 1,556 ) , obstetrics/gynecology ( n = 1,556 ) , and from one rheumatology practice ( n = 98 ) . Mean participant age was 64.3 years ( SD = 9.97 ) ; 89 % were Caucasian ; 59 % had some college education . Sixty-three percent used a single osteoporosis agent , usually a bisphosphonate . For monotherapy patients , concordance between clinic- and patient-reported medication use was lowest for patients prescribed estrogen therapy ( 70 % ) or calcium/vitamin D ( 72 % ) . Obstetrician/gynecologists enrolled younger women , who were more likely to use estrogen therapy than patients enrolled by other physicians . The 934 women ( 19 % ) prescribed only calcium/vitamin D were younger than women prescribed pharmacologic therapy . Conclusions POSSIBLE US ™ provides a unique foundation for evaluating longitudinal use of osteoporosis medications and related outcomes In this r and omized controlled trial , we examined the effects of a 3-month therapeutic lifestyle modification ( TLM ) intervention on knowledge , self-efficacy , and health behaviors related to bone health in postmenopausal women in rural Korea . Forty-one women ages 45 or older were r and omly assigned to either the intervention ( n = 21 ) or control ( n = 20 ) group . The intervention group completed a 12-week , 24-session TLM program of individualized health monitoring , group health education , exercise , and calcium-vitamin D supplementation . Compared with the control group , the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks , providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis Summary 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 . Introduction 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 , prospect i ve , r and omized study evaluated the efficacy of two different methods aim ed at improving adherence and persistence through greater patient involvement , compared with st and ard clinical practice . Methods Three hundred thirty-four post-menopausal women , receiving an oral prescription for osteoporosis for the first time , were recruited and r and omized into three groups : group 1 ( controls , managed according to st and ard 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 r and omized 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 BACKGROUND Aromatase inhibitors ( AIs ) have improved the prognosis for breast cancer survivors and are now st and ard of care for postmenopausal women with hormone receptor positive early stage breast cancer . One side-effect , however , is a decrease in bone mineral density ( BMD ) and increased fracture risk . Since hormone replacement therapy ( HRT ) is contraindicated in these women , one prevention option is exercise combined with vitamin D and calcium . The effect of this intervention on drug-induced osteoporosis is unknown . METHODS A single-blind r and omized controlled trial will be undertaken to test the hypothesis that exercise combined with vitamin D and calcium can prevent the decrease in BMD associated with the use of AIs . Sixty postmenopausal women prescribed an AI for the treatment of breast cancer will be r and omized into either an exercise or control group . Participants r and omized to the exercise group will undertake a 12-month gym-based exercise program , 3 times per week involving resistance and impact training . Participants in the control group will be advised on the benefits of exercise for preventing osteoporosis , but not prescribed exercise . Both groups will receive vitamin D and calcium supplements . The primary outcome will be total hip bone mineral density measured via dual energy X-ray absorptiometry ( DXA ) . Study outcomes will be compared between groups at baseline , 6months and 12months . SUMMARY This study will investigate the effect of exercise in combination with vitamin D and calcium on prevention of drug-induced osteoporosis in postmenopausal women prescribed AIs for the treatment of breast cancer ABSTRACT Objective : Non-adherence to oral bisphosphonate medications is a pervasive problem that blunts their potential to prevent fractures . Using multivariate modeling , we assessed the unique contribution of six classes of variables as drivers of non-adherence to bisphosphonates : ( 1 ) beliefs about osteoporosis and its prescription drug treatment , ( 2 ) ratings of the affordability of the prescription osteoporosis medications , ( 3 ) evaluations of the convenience of the bisphosphonate dosing frequency , ( 4 ) reports of troublesome side effects , ( 5 ) ratings of aspects of the bisphosphonate dosing regimen , and ( 6 ) risk factors for fracture . These categories of predictor variables were selected for investigation because they have been suggested by clinical -trial , survey , and observational studies in osteoporosis as reasons for non-adherence among patients taking prescription osteoporosis therapy . Methods : Women aged 45 or older who filled a prescription for an oral bisphosphonate in January or February of 2006 were identified through a dispensing data base of 3300 US retail pharmacies . Subjects received a mailed pre-notification letter from the retail pharmacy chain informing them that someone would be calling them to invite them to participate in a telephone survey about osteoporosis medications . Trained interviewers used a st and ardized telephone script to recruit patients . Our definition of adherence was provisionally based on data base records across a 7-month period and then cross-vali date d using patient self-report during the telephone recruitment . We measured beliefs regarding bisphosphonate effectiveness and safety , osteoporosis health concerns , concerns regarding drug costs , dosing frequency convenience , and experienced side effects using multi-item scales . Data were collected by telephone interview . Bivariate analyses were conducted using χ2 and t-tests , and multivariate analyses were conducted using logistic regression . Results : Of the 3274 women contacted for study participation , 1092 ( 33 % ) completed the interview and 1015 had analyzable data . Multivariate analyses showed that those most symptomatic in terms of side effects and those with the most skeptical beliefs in drug effectiveness and drug safety had odds ratios for non-adherence of 6.78 ( 95 % CI 4.67–9.86 ) , 5.70 ( 95 % CI 3.65–8.92 ) , and 2.26 ( 95 % CI 1.49–3.42 ) , respectively . In multivariate models , osteoporosis health concerns , dosing frequency convenience , and concerns regarding medication costs were not statistically associated with non-adherence to bisphosphonate therapy . Conclusions : The experience of troublesome side effects and patient beliefs regarding the effectiveness and safety of oral bisphosphonate medications prescribed for them are strongly associated with bisphosphonate non-adherence . Improving adherence to oral bisphosphonates may require providers to solicit and address patients ’ medication beliefs and to proactively address side effects . Limitations of our study include : ( 1 ) the study sample is not likely to be a national r and om sample of bisphosphonate users , and ( 2 ) some evidence of non-response bias was observed Summary Using a protocol led intervention program , pharmacists can decrease nonadherence to osteoporosis medication , by continuous monitoring and tailored counseling sessions , starting at treatment initiation . In the usual care group , 32.8 % of patients initiating osteoporosis medication discontinued or were nonadherent , compared to 19.0 % of patients in the intervention group . Purpose While community pharmacies have been shown to offer a promising platform for osteoporosis management in patients with osteoporosis , more research is needed to determine pharmacists ’ effects on improving adherence . The aim of this study was to determine the effects of a community pharmacists ’ intervention program on the 1-year discontinuation and nonadherence rates of patients initiating osteoporosis medication . Methods This intervention study included 937 patients , recruited from 13 Dutch community pharmacies , initiating osteoporosis medication . The intervention group ( N = 495 ) , received the Medication Monitoring and Optimization ( MeMO ) intervention , comprising of continuous monitoring of patients ’ adherence to their osteoporosis medication and tailored counseling sessions with nonadherent patients . Results were compared to an internal ( n = 442 ) reference group , receiving usual pharmacy care . Primary study outcomes were therapy discontinuation and nonadherence ; results were adjusted for potential confounders using Cox proportional hazard analysis . Secondary outcome was patients ’ satisfaction . Results In the usual care group , 32.8 % of patients initiating osteoporosis medication discontinued or were nonadherent , compared to 19.0 % of patients in the intervention group ( P < 0.001 ) . Ninety-three percent of the respondents were satisfied with the pharmacies ’ services provided . Notably , 31 % mentioned that the pharmacy was the only place where they received information on various aspects of administration and acting of their medication . Conclusion Pharmacists can decrease nonadherence and discontinuation with osteoporosis medication by providing tailored counseling sessions and continuous monitoring of drug use . Pharmaceutical care programs , such as MeMO , contribute to more optimal use of osteoporosis medication WHAT IS KNOWN AND OBJECTIVE Studies have shown that comprehensive interventions by pharmacists can improve adherence and persistence to osteoporosis therapy , but the association between adherence and bone turnover markers ( BTMs ) has never been studied . Therefore , the aim of this study was to evaluate the effects of pharmaceutical care on medication adherence ( and its effects on BTMs ) , as well as persistence of postmenopausal osteoporotic women to prescribed bisphosphonates . METHODS A r and omized controlled trial was conducted from 2005 to 2009 in the University Malaya Medical Centre , Malaysia . INCLUSION CRITERIA postmenopausal osteoporotic women diagnosed with osteoporosis with a T-score ≤ -2·5 or who had a low-trauma fracture and prescribed weekly alendronate/risedronate .  Intervention participants received counselling on osteoporosis , risk factors , lifestyle modifications , goals of therapy , side effects and the importance of adherence . Adherence was assessed at months 3 , 6 and 12 , and persistence at month 12 . Feedback on BTMs was provided at months 4 and 7 . The control group received no counselling . Two BTMs were used : serum C-terminal cross-linking telopeptide of type I collagen ( CTX-I ) and serum osteocalcin ( OC ) . MAIN OUTCOMES MEASURED medication adherence , BTMs and persistence . RESULTS AND DISCUSSION Intervention participants who received pharmaceutical care reported significantly higher medication adherence at 6 ( P = 0·015 ) and 12 months ( P = 0·047 ) compared with the control group ; but this effect was not shown by the BTMs . This is probably due to the long effect of bisphosphonates in bone . A significant difference was found between serum CTX-I and OC in identifying non-responders to anti-resorptive therapy ( P < 0·001 ) , indicating the usefulness of BTMs as an objective marker . However , pharmaceutical care did not affect persistence to osteoporosis therapy within a 1-year period [ log rank ( Mantel-Cox ) χ² = 0·496 , P = 0·481 ] . The proportion of participants who were persistent with bisphosphonate therapy after 12 months was 89·8 % and 87·0 % in the control and intervention group respectively . WHAT IS NEW AND CONCLUSION The provision of pharmaceutical care improved medication adherence but not persistence . BTMs were not appropriate objective measures for assessing adherence to weekly bisphosphonates but were useful for identifying non-responders to treatment within 3 - 6 months , much earlier than using bone mineral density . The study indicates that pharmacists have a role in improving medication adherence , but its long-term effect on persistence warrants further studies with longer duration Background Bisphosphonates can reduce fracture risk in patients with osteoporosis , but many at-risk patients do not start or adhere to these medications . The aims of this study are to : ( 1 ) preliminarily evaluate the effect of an individualized 10-year osteoporotic fracture risk calculator and decision aid ( OSTEOPOROSIS CHOICE ) for postmenopausal women at risk for osteoporotic fractures ; and ( 2 ) assess the feasibility and validity ( i.e. , absence of contamination ) of patient-level r and omization ( vs. cluster r and omization ) in pilot trials of decision aid efficacy . Methods / Design This is a protocol for a parallel , 2-arm , r and omized trial to compare an intervention group receiving OSTEOPOROSIS CHOICE to a control group receiving usual primary care .  Postmenopausal women with bone mineral density T-scores of < -1.0 , not receiving bisphosphonate therapy , and receiving care at participating primary care practice s in and around Rochester , Minnesota , USA will be eligible to participate in the trial . We will measure the effect of OSTEOPOROSIS CHOICE on five outcomes : ( a ) patient knowledge regarding osteoporosis risk factors and treatment ; ( b ) quality of the decision-making process for both the patient and clinician ; ( c ) patient and clinician acceptability and satisfaction with the decision aid ; ( d ) rate of bisphosphonate use and adherence , and ( e ) trial processes ( e.g. , ability to recruit participants , collect patient outcomes ) . To capture these outcomes , we will use patient and clinician surveys following each visit and video recordings of the clinical encounters . These video recordings will also allow us to determine the extent to which clinicians previously exposed to the decision aid were able to recreate elements of the decision aid with control patients ( i.e. , contamination ) . Pharmacy prescription profiles and follow-up phone interviews will assess medication start and adherence at 6 months . Discussion This pilot trial will provide evidence of feasibility , validity of patient r and omization , and preliminary efficacy of a novel approach -- decision aids -- to improving medication adherence for postmenopausal women at risk of osteoporotic fractures . The results will inform the design of a larger trial that could provide more precise estimates of the efficacy of the decision aid . Trial registration Clinical Trials.gov Identifier : Introduction Osteoporosis represents a growing public health concern ; however , current rates of management are sub-optimal . The aim of our study was to assess , in a r and omized controlled trial , the effect of a mailed educational intervention on older adults ’ knowledge , attitudes , and preventive behaviors regarding osteoporosis . The setting was a large publicly funded state pharmacy benefits program . The patients were 31,715 Medicare beneficiaries from Pennsylvania who participated in a drug benefits program for low-to-moderate income elderly people . Methods All women aged over 65 years , and all men and women with a history of fracture or long-term oral use of glucocorticoid , were included . Approximately half of the participants ( intervention group ) were r and omly selected to receive three mailings aim ed at improving knowledge of osteoporosis and enhancing preventive activities , such as using calcium and vitamin D , reducing fall risks in the home , obtaining a bone mineral density ( BMD ) test , and taking medications when necessary . The other participants did not receive the intervention mailings and served as controls . We surveyed a sample of intervention and control subjects to determine the effects of the intervention on knowledge , attitudes , self-efficacy ( confidence in one ’s ability to perform specific activities ) , and behavior regarding osteoporosis prevention and treatment . Six hundred r and omly selected participants in the intervention group and an equal number in the control group were invited to participate . Results Twenty-six had died and 636 of the remaining 1,185 ( 54 % ) completed the survey . Respondents and non-respondents did not differ significantly with respect to measured sociodemographic factors . All scales had good reliability ( all Cronbach ’s alphas > 0.65 ) . Knowledge of osteoporosis was generally very good and did not differ between intervention ( mean = 65 % correct responses ) and control subjects ( mean = 67 % correct ; P=0.4 ) . Perceived susceptibility to osteoporosis was relatively high and similar across groups ( P=0.4 ) . Self-efficacy for participating in osteoporosis prevention and treatment was very strong in both the intervention ( mean = 4.3 on a 0–5 scale ) and control ( mean = 4.2 , P=0.03 ) groups . On average , subjects in the intervention group reported participating in 3.5 of 6 preventive osteoporosis activities compared with 3.4 in the control group ( P=0.5 ) . Conclusions Compared with the controls , a mailed educational intervention for osteoporosis was not associated with better knowledge , higher perceived susceptibility , or performance of preventive measures among the at-risk older adults that we studied . The intervention group demonstrated a small increase in self-efficacy . More intensive patient interventions or intervention aim ed at other aspects of the care process may be required to bring about changes that lead to a reduction in fractures Summary This study evaluated the effect of a multifaceted intervention ( screening and patient education ) by community pharmacists on testing or treatment of osteoporosis . One hundred and twenty-nine patients r and omized to receive the intervention were compared to 133 patients who did not receive the intervention . Twice as many patients who got the intervention received further testing or treatment for osteoporosis . Introduction The objective of this study was to determine the effect of a community pharmacist screening program on testing and treatment of osteoporosis . Methods In this r and omized , controlled trial , 262 patients meeting bone mineral density ( BMD ) testing guidelines [ men or women aged ≥ 65 years or 50–64 years with one major risk factor including previous fracture , family history of osteoporosis , glucocorticoids for > 3 months , or early menopause ] were allocated to intervention ( 129 ) or control ( 133 ) . Intervention consisted of printed material s , education , and quantitative ultrasound . Primary outcome was a composite endpoint of BMD or prescription for osteoporosis medication within 4 months . Results Primary endpoint of BMD or osteoporosis treatment was achieved by 28 intervention patients ( 22 % ) compared with 14 controls ( 11 % ) ( RR 2.1 , 95 % CI 1.1–3.7 ) . This was driven by BMD testing ( 28 ( 22 % ) vs. 13 ( 10 % ) for controls , p = 0.011 ) . Calcium intake increased more among intervention patients than controls ( 30 % vs. 19 % , RR 1.6 , 95 % CI 1.0–2.5 ) . There was no effect on knowledge or quality of life . Conclusion A pharmacist screening program doubled the number of patients tested for osteoporosis . Nevertheless , many patients eligible for BMD did not receive appropriate care suggesting more intensive interventions are needed BACKGROUND Multiple studies demonstrate poor adherence to medication regimens prescribed for chronic illnesses , including osteoporosis , but few interventions have been proven to enhance adherence . We examined the effectiveness of a telephone-based counseling program rooted in motivational interviewing to improve adherence to a medication regimen for osteoporosis . METHODS We conducted a 1-year r and omized controlled clinical trial . Participants were recruited from a large pharmacy benefits program for Medicare beneficiaries . All potentially eligible individuals had been newly prescribed a medication for osteoporosis . Consenting participants were r and omized to a program of telephone-based counseling ( n = 1046 ) using a motivational interviewing framework or a control group ( n = 1041 )  that received mailed educational material s.  Medication regimen adherence was the primary outcome compared across treatment arms and was measured as the median ( interquartile range ) medication possession ratio , calculated as the ratio of days with filled prescriptions to total days of follow-up . RESULTS The groups were balanced at baseline , with a mean age of 78 years ; 93.8 % were female . In an intention-to-treat analysis , median adherence was 49 % ( interquartile range , 7%-88 % ) in the intervention arm and 41 % ( 2%-86 % ) in the control arm ( P = .07 , Kruskal-Wallis test ) . There were no differences in self-reported fractures . CONCLUSION In this r and omized controlled trial , we did not find a statistically significant improvement in adherence to an osteoporosis medication regimen using a telephonic motivational interviewing intervention OBJECTIVES As many as one-half of patients recommended for osteoporosis pharmacotherapy  do not take their medications . To identify intervention targets , we examined patient characteristics associated with nonadherence to recommended pharmacotherapy and their reasons for nonadherence . METHODS Data come from the Patient Activation after DXA Result Notification ( PAADRN ) study , a r and omized controlled trial of 7749 patients aged 50 years or older presenting for dual-energy X-ray absorptiometry ( DXA ) at 3 health centers in the United States . We focused on the 790 patients who reported receiving a recommendation for new pharmacotherapy at baseline . Using Pearson chi-squared tests for categorical variables , 2- sample t tests for continuous variables , and multivariable multinomial logistic regression , we compared those who reported starting the recommended medication ( adherers ) with temporary nonadherers and nonadherers on demographics , health habits , DXA impression , 10-year probability of fracture using the assessment tool , and osteoporosis knowledge , and we examined their stated reasons for nonadherence . RESULTS Mean age was 66.8 years ( SD = 8.9 ) ; 87.2 % were women , and 84.2 % were white . One-fourth of patients ( 24.8 % ) reported that they did not start their recommended pharmacotherapy . In the unadjusted analyses , the only factor significantly associated with nonadherence was osteoporosis knowledge , with those having better knowledge being less likely to take their medications ( P < 0.05 ) . The most common reasons for nonadherence were fear of adverse effects ( 53.3 % ) , a dislike of taking medicine ( 25.3 % ) , and the belief that the medication would not help their condition ( 16.7 % ) . CONCLUSION One in 4 patients recommended for osteoporosis pharmacotherapy declined treatment because they feared potential adverse effects , did not like taking medicine , or believed that the medication would not help their condition . Improved patient counseling on the potential adverse effects of osteoporosis treatment and the risk-benefit ratio for these medications may increase adherence Aim : The aim of the following study is to evaluate adherence and compliance of postmenopausal osteoporotic patients for different regimens of bisphosphonates ( BP ) . Material s and Methods : A prospect i ve observational r and omized comparative 1 year study was undertaken to evaluate the adherence/compliance rates of most commonly prescribed daily alendronate ( ALN ) , weekly risedronate ( RIS ) and monthly ib and ronate ( IBN ) BP regimens . Results : Nearly 40 % was the 1 year adherence rate with BP and 41.33 % of non-compliance . Whereas , 8.66 % was interrupted compliance rate and 6 % switched over to other anti-osteoporotic treatment . The three treatment arm did not vary significantly . However , numerically maximum adherence rate of 56 % was recorded in monthly BP regimen followed by weekly ( 36 % ) and daily regimen ( 32 % ) . Medication possession rate confirmed on a follow-up visit was maximum with monthly regimen as 84.61 % followed by daily ( 62.5 % ) and weekly ( 61.11 % ) respectively . Average time in days for non-adherence was 48 , 56 and 92 day with daily ALN , weekly RIS and monthly IBN regimen respectively . Age , mean age at menopause , demographical profile failed to influence the adherence . Concomitant treatment for co-morbid condition ( 57.14 % ) , unawareness about osteoporosis ( OP ) ( 50 % ) , cost of treatment ( 45.33 % ) , belief that drugs is for their general disability ( 39.28 % ) , physician 's failure to stress the need and necessary calcium + vitamin D daily requirement ( 23.80 % ) each were the most prevalent factors responsible for non-adherence . Intolerance and adverse drug reactions were responsible for only 13.09 % and 11.90 % of non-adherence . Conclusion : Treatment compliance is poor with daily ALN , weekly RIS and monthly IBN regimen along with calcium and vitamin D3 in Indian paramedical workers suffering OP Treatment nonadherence is a recognized problem , but most practice setting s use education alone to address it . Psychological counseling methods generate greater behavior change but are not widely used . Telehealth nursing can be used to integrate these methods into routine clinical practice . This study was a nonr and omized trial of a telehealth program that used motivational interviewing and cognitive— behavioral techniques to improve osteoporosis medication adherence .  Registered nurses delivered the intervention to 402 participants recruited from provider offices across the United States .  Initial participation rates were high in this community-based sample , although attrition also was high . Six-month adherence based on pharmacy and clinical interview data was significantly higher than the general population rate . A comparison with non participants approached significance , and there was a significant dose — response effect . Most reasons given for nonadherence were psychological . The results support the use of psychological techniques to improve adherence and the use of telehealth to disseminate evidence -based patient counseling . ( Am J Med Qual 2007;22 445 - 456 Background Adherence to anti-osteoporosis treatments is poor , exposing treated women to increased fracture risk . Determinants of poor adherence are poorly understood . The study aims to determine physician- and patient- rated treatment compliance with osteoporosis treatments and to evaluate factors influencing compliance . Methods This was an observational , cross-sectional pharmacoepidemiological study with a r and omly-selected sample of 420 GPs , 154 rheumatologists and 110 gynaecologists practicing in France . Investigators included post-menopausal women with a diagnosis of osteoporosis and a treatment initiated in the previous six months . Investigators completed a question naire on clinical features , treatments and medical history , and on patient compliance . Patients completed a question naire on sociodemographic features , lifestyle , attitudes and knowledge about osteoporosis , treatment compliance , treatment satisfaction and quality of life .  Treatment compliance was evaluated with the  Morisky Medication-taking Adherence Scale . Variables collected in the question naires were evaluated for association with compliance using multivariate logistic regression analysis . Results 785 women were evaluated . Physicians considered 95.4 % of the sample to be compliant , but only 65.5 % of women considered themselves compliant . The correlation between patient and physician perceptions of compliance was low ( κ : 0.11 [ 95 % CI : 0.06 to 0.16 ] ) . Patient-rated compliance was highest for monthly bisphosphonates ( 79.7 % ) and lowest for hormone substitution therapy ( 50.0 % ) . Six variables were associated with compliance : treatment administration frequency , perceptions of long-term treatment acceptability , perceptions of health consequences of osteoporosis , perceptions of knowledge about osteoporosis , exercise and mental quality of life . Conclusion Compliance to anti-osteoporosis treatments is poor . Reduction of dosing regimen frequency and patient education may be useful ways of improving compliance
Collectively , these studies provided some evidence to show that interventions by healthcare professionals improved the QOL medication compliance and calcium intake of patients but its effects on BMD , medication persistence , knowledge , and other lifestyle modifications were less conclusive .
Summary A systematic review was conducted to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women .
Evidence available indicates that such interventions are effective in improving the quality of life , medication compliance , and calcium intake , but effect on other outcomes is less conclusive .
Introduction The purpose of this study is to conduct a systematic review to evaluate evidence concerning the effect of non-drug interventions by healthcare professionals on community-dwelling postmenopausal osteoporotic women .