UCLA/Cedars-Sinai, Los Angeles, USA.
Osteoporos Int. 2012 Mar;23(3):1069-74. doi: 10.1007/s00198-011-1721-z. Epub 2011 Jul 14.
We examined how the use of bone turnover markers and educational information affects persistence of bisphosphonate use in osteoporotic patients. We found that reporting bone turnover results and/or educational information did not affect persistence.
Long-term adherence and persistence to osteoporosis medication are poor. We examined whether reporting of bone turnover marker results, education about osteoporosis, or a combination of both would increase persistence to oral bisphosphonates.
Two hundred and forty women who were 5 years postmenopausal with BMD at least 2.0 standard deviations below normal were recruited for the study. All women were given a new prescription for alendronate and randomly assigned to one of four groups: (1) bone marker results at baseline, 3 and 12 months; (2) educational materials every month and a membership in the National Osteoporosis Foundation; (3) bone marker and educational information; and (4) control, no information other than usual care. Persistence among randomization groups was tested using survival analysis adjusting for the delay between intervention methods.
Of those filling their initial prescription, 95.5% refilled their prescription at the end of the first month, 87% at 3 months, 82% at 6 months, and 78% at 10 months. Overall persistence through 12 months was 54%. There was no difference found among the four groups for persistence time using (p > 0.58).
Providing bone turnover marker results is not an effective way to enhance early compliance and persistence with drug therapy. While the women in our study felt that bone marker results and educational information were helpful to them, there was no difference in persistence between those who received either bone marker information and/or educational information and those who did not. Because of the unexpected rate of primary nonadherence, this study may be underpowered.
我们研究了使用骨转换标志物和教育信息如何影响骨质疏松症患者对双膦酸盐的持续使用。我们发现，报告骨转换结果和/或教育信息并不影响持续使用。
长期坚持和持续使用骨质疏松症药物的情况不佳。我们研究了报告骨转换标志物结果、骨质疏松症教育或两者结合是否会增加口服双膦酸盐的持续使用。
招募了 240 名绝经后至少 5 年且 BMD 至少低于正常标准 2 个标准差的女性参加研究。所有女性均获得了阿伦膦酸盐的新处方，并随机分为四组之一：（1）基线、3 个月和 12 个月的骨标志物结果；（2）每月教育材料和全国骨质疏松基金会会员资格；（3）骨标志物和教育信息；（4）对照组，除常规护理外无其他信息。使用生存分析调整干预方法之间的延迟来测试随机分组之间的持久性。
在填写初始处方的人中，95.5%在第一个月结束时再次开处方，87%在第 3 个月，82%在第 6 个月，78%在第 10 个月。总体而言，12 个月时的持续率为 54%。在持久性方面，四组之间没有差异（p>0.58）。
提供骨转换标志物结果并不是提高药物治疗早期依从性和持久性的有效方法。虽然我们研究中的女性认为骨标志物结果和教育信息对她们有帮助，但在接受骨标志物信息和/或教育信息与未接受信息的患者之间，持续时间没有差异。由于最初非依从率的意外率，本研究可能没有足够的效力。
