Introduction
Methods
Search strategy
Selection criteria
Definitions of adherence and persistence
Extracted information
Type of interventions
Study quality
Synthesis of results
Results
Literature search
Study characteristics
Author | Country | Year | Setting | Study design | Inclusion criteria | Number of patients included | Planned follow-up | Administered by | |
---|---|---|---|---|---|---|---|---|---|
Patient education | |||||||||
1 | Roux et al. | Canada | 2013 | Secondary care | RCT | Aged ≥ 50 years with a fragility fracture | I1 370 I2 311 C 200 | 12 months | Allied health professionals and primary care physicians |
2 | Tüzün et al. | Turkey | 2013 | Secondary care | RCT | Women aged between 45 and 75 years with postmenopausal osteoporosis and eligible for oral bisphosphonates | I1 222 I2 226 C NR | 12 months | NR |
3 | Bianchi et al. | Italy | 2015 | Secondary care | RCT | Females aged 45–80 years, diagnosed with post-menopausal osteoporosis, receiving a first prescription of an oral drug for OP | I1 110 I2 111 C 113 | 12 months | Hospital staff (physicians and nurses) |
4 | Cram et al. | USA | 2016 | Secondary care | RCT | Aged ≥ 50 presenting for DXA. | I 3.917 C 3.865 | 12 weeks | Physicians, nurse practitioners, and physician assistants |
5 | Gonnelli et al. | Italy | 2016 | Secondary care | RCT | Osteoporotic woman aged ≥ 50 receiving a prescription of an oral osteoporosis medication for the first time | I 402 C 414 | 12 months | Physician NS |
6 | LeBlanc et al. | Australia | 2016 | Secondary care | RCT | English speaking woman aged ≥ 50 with a diagnosis of osteopenia or osteoporosis, not taking anti-osteoporotic medication | I1 33 I2 32 C 14 | 6 months | Nurse practitioners and physician assistants |
7 | Seuffert et al. | USA | 2016 | Secondary care | Observational study | Patients with osteoporosis or osteopenia diagnosed after DXA | I 447 C 347 | 12 months | Nurse practitioner |
8 | Beaton et al. | Canada | 2017 | Secondary care | Cohort study | Fragility fracture patients (≥ 50 years; hip, humerus, forearm, spine, or pelvis fracture) | I 147.071 C NR | 12 months | A trained coordinator |
9 | Danila et al. | USA | 2018 | Secondary care | RCT | Women with self-reported fracture history after age 45 years not using osteoporosis therapy | I 1.342 C 1.342 | 18 months | NR |
Drug regimen | |||||||||
10 | Stuurman-Bieze et al. | The Netherlands | 2014 | Primary care (pharmacist) | Intervention study | Patients initiating osteoporosis medication or a fixed combination with supplements | I 495 C 442 | 12 months | Pharmacist |
11 | Oral et al. | Turkey and Poland | 2015 | Secondary care | Crossover RCT | Women with postmenopausal osteoporosis aged 55 to 85 years, eligible for anti-osteoporosis treatment | I/C 4481 | 26 weeks | NR |
12 | Tamechika et al. | Japan | 2018 | Secondary care | RCT | Systemic rheumatic diseases aged ≥ 20 years, receiving systemic glucocorticoid treatment or risedronate tablets | I 74 C 71 | 76 weeks | NR |
Monitoring and supervision | |||||||||
13 | Ducoulombier et al. | France | 2015 | Secondary care | RCT | Women aged > 50 years, a documented osteoporosis-related fracture warranting initiation of an oral anti-osteoporosis treatment | I 79 C 85 | 12 months | Medical secretaries |
14 | van den Berg et al. | Netherlands | 2018 | Secondary care | RCT | Female aged ≥ 50 years attending the FLS due to a recent non-vertebral or clinical vertebral fracture. | I 60 C 59 | 12 months | FLS nurse |
Interdisciplinary collaboration | |||||||||
15 | Ganda et al. | Australia | 2014 | Primary and secondary care | RCT | Aged > 45 years and sustained a symptomatic fracture due to minimal trauma | I 53 C 49 | 24 months | FLS staff (NS) and PCP |
Author | Intervention | Single/multicomponent Outcome | Defined as | Results | Conclusion | |
---|---|---|---|---|---|---|
Patient education and supervision | ||||||
1 | Roux et al. | Intervention group one (I1) ▪ Educational material ▪ Phone calls Intervention group two (I2)l ▪ Educational material ▪ Phone calls ▪ Blood tests and BMD test prescription ▪ Extra involvement primary care physician Control ▪ Usual care | Initiation | Initiation of osteoporosis treatment by primary care physician 12 months after a fragility fracture | I1 vs. C OR 2.55 95% CI 1.58–4.12 I2 vs. C OR 5.07 95% CI 3.13–8.21 | Information and follow-up by primary care physician improved treatment initiation. Additional blood tests and BMD test prescription have no statistically significant effect on treatment initiation. |
2 | Tüzün et al. | Intervention group one (I1) ▪ Educational material Intervention group two (I2) ▪ Educational material ▪ Patient counseling ▪ Group meetings ▪ Phone calls Control group ▪ Not reported | Implementation | Receiving treatment as per the instructions of the physician at regular intervals and dosages. | I1 49.5% I2 50.5% p value 0.86 | Active or passive training does not improve adherence to anti-osteoporosis medication. |
Discontinuation | Continuing to receive treatment over the long term | I1 43.8% I2 56.2% p value 0.48 | ||||
3 | Bianchi et al. | Intervention group one (I1) ▪ Usual care ▪ Educational material ▪ Alarm clock ▪ Suggestions about the use of reminders Intervention group two (I2) ▪ Usual care ▪ Educational material ▪ Alarm clock ▪ Suggestions about the use of reminders ▪ Phone calls ▪ Group meetings Control group ▪ Usual care | Implementation | The percentage of the prescribed dose taken | I1 41% I2 48% C 49% No p value provided | Providing information and an alarm clock or telephonic reminders and patient meetings does not improve adherence and persistence. |
Persistence | Taking the medication 10 out of 12 months without pauses longer than 2 weeks | I1 90% I2 85% C 92% p value 0.29 | ||||
4 | Cram et al. | Intervention group one (I1) ▪ Educational brochure ▪ Provision of the test results Control group ▪ Usual care | Adherence | Not defined | I1 75.1% C 75.0% No p value provided | Tailored letters providing patients with the DXA score and educational material does not improve adherence. |
5 | Gonneli et al. | Intervention group one (I1) ▪ Provision of educational material Control group ▪ Usual care | Implementation | Morisky Medication Adherence Scale (MMAS) ≥ 75% | I1 64.2% C 58.1% No p value provided | Providing the patients with their individual fracture risk information was not effective to improve adherence or persistence. |
Persistence | Case reports, not specified | I1 66.8% C 62.6% No p value provided | ||||
6 | Leblanc et al. | Intervention group one (I1) ▪ Decision aid discussed during the consultation ▪ Patient counseling Intervention group two (I2) ▪ Provision of FRAX-results ▪ Patient counseling Control group ▪ Usual care | Implementation | Percentage of days covered ≥ 80% | I1 46.7% I2 + C 85% p value 0.08 | Supporting both patients and clinicians during the clinical encounter with the Osteoporosis Choice decision aid does not improve treatment decision-making when compared with usual care with or without clinical decision support with FRAX results. |
7 | Seuffert et al. | Intervention group one (I1) ▪ Educational material ▪ Provision of the test-results ▪ Referral to an endocrinologist when indicated Control group ▪ Usual care | Implementation | Active treatment 12 months after initiation | Females I1 95% C 90% p value 0.04 Males I1 97% C 82% p value 0.04 | An educational program combined with a referral to an endocrinologist improves the treatment adherence. |
8 | Beaton et al. | Intervention group one (I1) ▪ Identification of patients at risk of osteoporosis by a screening coordinator ▪ Offering education to both patient and primary care provider | Implementation | Proportion of days covered (PDC) ≥ 50% | I1 56.4% C 54.2% p value 0.02 | A screening coordinator does not improve adherence. |
Implementation | Proportion of days covered (PDC) ≥ 80% | I1 pre intervention 59.9% Post intervention 56.4% p value 0.02 | ||||
9 | Danila et al. | Intervention group one (I1) ▪ Provision of educational material containing of video material Control group ▪ Usual care | Implementation | Self-report of current osteoporosis medication use at 6 months. | I1 11.7% C 11.4% p value 0.83 | A multi-modal tailored direct-to-patient video intervention does not change the adherence to anti-osteoporosis medication or testing. |
Drug regimen combined with patient support | ||||||
10 | Stuurman-Bieze et al. | Intervention group one (I1) ▪ Patient counseling ▪ Signaling of non-adherence ▪ Offering patients an alternative in case of non-adherence Control group ▪ Usual care | Implementation | Medication possession rate ≤ 80% | I1 96.8% C 95.0% p value 0.18 | Counseling sessions by pharmacists did not improve implementation of osteoporosis medication. By providing tailored counseling sessions, pharmacists are able to improve non-discontinuation of anti-osteoporotic medication. |
Discontinuation | Permanent stopping anti-osteoporosis medication | I1 84.2% C72.2% p value < 0.01 | ||||
11 | Oral et al. | Intervention group one (I1) ▪ Cross-over medication scheme Control group ▪ Usual care | Implementation | > 50% dose taken | I1 59.9% C 61.9% p value 0.46 | A flexible dosing regimen can improve non-discontinuation of anti-osteoporosis medication. It does however not affect implementation. |
Discontinuation | Continuation of treatment after 26 weeks | I1 86.0% C 78.9% p value 0.03 | ||||
12 | Tamechika et al. | Intervention group one (I1) ▪ Switching from weekly bisphosphonates to monthly minodronate Control group ▪ Usual care | Adherence | Not defined | I1 99.4% C 99.5% No p value provided | Switching from weekly bisphosphonates to monthly minodronate does not improve adherence to anti-osteoporosis medication. |
Monitoring and supervision | ||||||
13 | Ducoulombier et al. | Intervention group one (I1) ▪ Phone calls ▪ Patient counseling Control group ▪ Usual care | Implementation | Medication possession rate ≥ 80% | I1 64.6% C 32.9% p value < 0.01 | Telephonic follow-ups enhance patient’s implementation and non-discontinuation. |
Discontinuation | Continuing to take a medication after 12 months | I1 72.6% C 50.6% p value < 0.01 | ||||
14 | van den Berg et al. | Intervention group one (I1) ▪ Phone calls Control group ▪ Usual care | Persistence | Not defined | I1 93.0% C 88.0% No p value provided | Telephonic follow-up of osteoporosis patients does not improve persistence. |
Interdisciplinary collaboration | ||||||
15 | Ganda et al. | Intervention group one (I1) ▪ Transferring the patient to the GP after 3 months Control group ▪ Usual care | Implementation | Medication possession rate ≥ 80% | I1 64.0% C 61.0% p value 0.75 | Transferring the care from the FLS clinic to the GP has no influence on implementation. |
Author | Study population and setting | Inclusion criteria | Exclusion criteria | Activities and intensity of intervention | Component | Effects | |
---|---|---|---|---|---|---|---|
Patient education and supervision | |||||||
1 | Roux et al. | Patients who present themselves with a hip fracture or attending the orthopedic fracture clinic at Centre Hospitalier Universitaire de Sherbrooke | Aged ≥ 50 years, hospitalized with a hip fracture or were seen at the orthopedic fracture clinics with a fragility fracture | Psychiatric and cognitive problems, language barriers | I1 Information to patient and primary care physician. Follow-up calls at 6 and 12 months. 2nd intervention if not treated at 6 months I2 Extra information to patient and primary care physician. Follow-up calls at 4, 8, and 12 months. 2nd intervention if not treated at 6 months. Blood test and BMD prescription C Usual care | Multi-component | Initiation + |
Implementation NR | |||||||
Discontinuation NR | |||||||
Persistence NR | |||||||
2 | Tüzün et al. | Women aged between 45 and 75, diagnosis of postmenopausal osteoporosis, eligible for osteoporosis treatment with weekly oral bisphosphonates Centre NS | Women aged between 45 and 75 years, had a diagnosis of postmenopausal osteoporosis according to WHO criteria, and had a clinical presentation appropriate for osteoporosis treatment with weekly oral bisphosphonates | Secondary osteoporosis, receiving anti-osteoporosis treatment | I1 Educational material (booklets osteoporosis in general, osteoporosis and exercise, osteoporosis and nutrition, osteoporosis and patient) at baseline. I2 Educational material (booklets osteoporosis in general, osteoporosis and exercise, osteoporosis and nutrition, osteoporosis and patient) at baseline. Group meetings with the topics (1) Osteoporosis in General (2), Osteoporosis and Exercise,( 3) Osteoporosis and Nutrition, and (4) Osteoporosis and Patient Rights 3, 6, 9, 12 months. Follow-up phone calls to remind patients to read the information booklets 2, 5, 8, 11 months | Multi-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation -/- | |||||||
Persistence NR | |||||||
3 | Bianchi et al. | The study design is a multicenter, prospective, randomized study of women affected by primary post-menopausal osteoporosis, starting oral therapy. Carried out at six Italian hospital centers distributed in Northern. Central and Southern Italy | Female aged 45–80 years, diagnosis of post-menopausal osteoporosis receiving a prescription of an oral drug for osteoporosis for the first time Possess the ability to read and understand simple educational materials and to answer simple questionnaires, availability for phone calls, and ability to come to the hospital’s outpatient clinic for meetings | On oral therapy at beginning of the study, secondary osteoporosis, affected by other diseases requiring complex drug therapy, severe cognitive, visual, or hearing impairment | I1 Usual care Two booklets providing information on osteoporosis and the importance of adherence to treatment. Colored memo stickers for a calendar or diary, a small alarm clock, suggestions about the use of these reminders to improve adherence to therapy I2 Similar to group one with the addition of phone calls (every 3 months) to remind patients to take the medication and invite patients to the informational group meetings (4 meetings during the 12 months) Content of the meetings were not specified C Usual care. | Multi-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation NR | |||||||
Persistence -/- | |||||||
4 | Cram et al. | Patients presenting themselves for a DXA at three health centers, the University of Iowa. the University of Alabama at Birmingham (UAB), and Kaiser Permanente of Georgia (KPGA) | Age ≥ 50. presenting for DXA | Age < 50, prisoners, overt cognitive disability, unable to speak or read English, deaf, no access to telephone | I1Usual care. Mailed tailored-letter with their DXA results accompanied by an educational brochure C Usual care | Multi-component | Initiation NR |
Implementation NR | |||||||
Discontinuation NR | |||||||
Persistence NR | |||||||
5 | Gonnelli et al. | Osteoporotic women aged 50 years or over receiving a prescription of an oral osteoporosis medication for the first time were recruited at 34 Italian outpatient centers (Departments of Internal Medicine. Rheumatology. Rehabilitation and Geriatrics) | Women aged ≥ 50 years or over, referred as outpatients for a follow-up visit 12 months after receiving a prescription of an oral osteoporosis medication (bisphosphonates, strontium ranelate, and selective estrogen receptor modulators [SERMs]) for the first time. Osteoporosis was defined as a T-score B-2.5 at lumbar spine and/or hip evaluated by dual X-ray absorptiometry (DXA) according to the WHO criteria | Presence of malignancies, multiple myeloma, Paget’s disease of bone, hyperparathyroidism, history of alcohol abuse (400 g/week), severe hearing or visual impairment, cognitive problems which would prevent reliable participation to the study, and any history of fragility fractures in the last 12 months | I1Usual care Detailed information about individual fracture risk along with a leaflet containing the absolute fracture risk value by DeFRA algorithm (group 2; n = 402) C Usual care | Multi-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation NR | |||||||
Persistence -/- | |||||||
6 | LeBlanc et al. | Women age over 50 with a diagnosis of osteopenia or osteoporosis from participating practices (family medicine, preventive medicine, primary care internal medicine, and general internal medicine) were all affiliated to the Mayo Clinic (Rochester, MN, USA) | Women aged over 50, with a diagnosis of osteopenia or osteoporosis, were not taking bisphosphonates or other prescription medications to treat their condition, were identified by their clinician as potentially eligible for bisphosphonates, were available for a 6-month follow-up after randomization, and had no major learning barriers | N/R | I1 Patients were provided a decision aid consisting their individualized 10-year risk of having a bone fracture estimated using the FRAX calculator and potential side effect of bisphosphonates I2 Clinicians providing patients their individualized 10-year risk of having a bone fracture estimated using the FRAX calculator C Usual care | Multi-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation NR | |||||||
Persistence NR | |||||||
7 | Seuffert et al. | Patients who visit an orthopedic office NS. | Patients diagnosed with osteoporosis by DXA (T-score − 2.5 and below) or a recent fragility fracture. Presence of osteopenia was also noted (defined as a T-score between − 1.1 and − 2.5) | N/R | I1 Educated by a nurse practitioner about the DXA results, calcium and vitamin D supplementation, provision of materials (brochures published by the National Osteoporosis Foundation) • C Usual care and a letter with the patients’ DXA score | Multi-component | Initiation NR |
Implementation + | |||||||
Discontinuation NR | |||||||
Persistence NR | |||||||
8 | Beaton et al. | Patients who are identified by the Fracture Clinic Screening Program (FCSP) | Fragility fracture patients. | Having a prescription filled < 12 months before the fracture | I1Identification of patients at risk of osteoporosis, educational material, intensity not specified | Multi-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation NR | |||||||
Persistence NR | |||||||
9 | Danila et al. | Patients included in the Activating Patients at Risk for OsteoPorOsiS (APRROPOS)-study. | Women aged ≥ 45 with a self-reported fracture | N/R | I1 Educational videos emailed and sent through DVD containing an (1) introduction video explaining the reason for receiving the materials, (2) personalized videos addressing barriers to osteoporosis therapy or presenting general osteoporosis information (for those who did not rank barriers to treatment), and (3) a video on “How to communicate with your doctor about bone health” C Usual care | Single-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation NR | |||||||
Persistence NR | |||||||
Drug regimen combined with patient support | |||||||
10 | Stuurman-Bieze et al. | Patients initiating osteoporosis medication, recruited from 13 Dutch community pharmacies | All patients who initiated osteoporosis medication registered in the participating pharmacies between March 2006 and March 2007 | N/R | I1 Patient counseling during the first two dispensary moments Active monitoring and signaling, 3 months after initiating medication. Non-adherent patients were intervened if warranted. C Usual pharmacy care | Multi-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation + | |||||||
Persistence NR | |||||||
11 | Oral et al. | Women with post-menopausal osteoporosis enrolled in 10 centers in Turkey and 9 centers in Poland | Ambulatory women aged 55 to 85 years, eligible for anti-osteoporosis treatment | N/R | I1 Switching with drug regimen at 1, 2, 3, and 23 weeks to the preferred regimen | Single-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation + | |||||||
Persistence NR | |||||||
12 | Tamechika et al. | Patients with systemic rheumatic disease, aged ≥ 20, receiving systemic glucocorticoid from rheumatology clinics in Nagoya City University Hospital, Kainan Hospital, and Nagoya City West Medical Center | Systemic rheumatic disease, aged ≥ 20 receiving systemic glucocorticoid and weekly oral alendronate or risedronate tablets before screening | Taking bisphosphonates other than weekly oral alendronate or risedronate tablets previously taking parathyroid hormone analogues, denosumab, or other investigational new drugs for the treatment of osteoporosis | I1:24 weeks bisphosphonates followed by 52 weeks minodronate C Usual care | Single-component | Initiation NR |
Implementation NR | |||||||
Discontinuation NR | |||||||
Persistence NR | |||||||
Monitoring and supervision | |||||||
13 | Ducoulombier et al. | Patients attending a FLS | Women aged ≥ 50 years A documented osteoporosis-related fracture warranting initiation of oral osteoporosis medication. | Previously used osteoporosis medication | I1:Two monthly phone calls lasting 10 min by medical secretaries to detect any difficulties in complying with the treatment and to remind patients to the importance of continuation the treatment as prescribed. When poor adherence was signaled, the secretary advised the patient to consult the primary care physician C Usual care | Multi-component | Initiation NR |
Implementation + | |||||||
Discontinuation + | |||||||
Persistence NR | |||||||
14 | van den Berg et al. | Patients attending a FLS | Females aged ≥ 50 years attending the FLS due to a recent non-vertebral or clinical vertebral fracture | Metabolic bone disorders | I1:Phone calls in months 1, 4, and 12 to remind the patient to take the medication and to exchange views on the side effects C Usual care | Single-component | Initiation NR |
Implementation NR | |||||||
Discontinuation NR | |||||||
Persistence- | |||||||
Interdisciplinary collaboration | |||||||
15 | Ganda et al. | Patients attending the FLS-clinic | Aged > 45 years and sustained a symptomatic fracture due to minimal trauma | Unable to provide informed consent, resided in a nursing home or hostel at the time of the incident fracture, a life expectancy < 3 years, not having a local medical practitioner, malignant or metabolic bone disease, gastrointestinal malabsorption syndromes, contra-indications to oral antiresorptive therapy | I1:3 months visit at the FLS 21 months care by the primary care provider C Usual care of 24-month follow-up at the FLS | Single-component | Initiation NR |
Implementation -/- | |||||||
Discontinuation NR | |||||||
Persistence NR |