Ye Carrie, McAlister Finlay A, Bellerose Debbie, Lin Meng
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Data and Research Services, Alberta SPOR Support Unit and Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada.
J Bone Metab. 2024 Feb;31(1):13-20. doi: 10.11005/jbm.2024.31.1.13. Epub 2024 Feb 29.
In this pre-planned variation of the Comparing Strategies Targeting Osteoporosis to Prevent Fractures After an Upper Extremity Fracture (C-STOP) trial, we investigated whether adherence-specific coaching by the case manager (CM) further improved the adherence and persistence rates compared to those seen in the C-STOP trial.
We conducted a prospective observational cohort study of community-dwelling adults 50 years or older who suffered an upper-extremity fracture and were not previously treated with osteoporosis medications, to assess whether a well-trained CM can partner with patients to improve adherence to and persistence with oral bisphosphonate intake. The primary outcome was adherence (taking > 80% of prescribed doses) to oral bisphosphonate intake at 12 months after study enrollment. Secondary outcomes included primary adherence to and 12-month persistence with oral bisphosphonate and calcium and vitamin D supplement intake at 12 months.
The study cohort consisted of 84 participants, of which 30 were prescribed an oral bisphosphonate. Twenty-two (73.3%) started treatment within 3 months. The adherence rate at 12 months was 77.3%. The persistence rate at 12 months was 95.5%. Of those not prescribed an oral bisphosphonate, 62.8% were taking supplemental calcium and 93.0% were taking supplemental vitamin D at 12 months. Depression was a significant predictor of 12-month non-adherence (adjusted odds ratio, 9.8; 95% confidence interval, 1.2-81.5).
Adherence-specific coaching by a CM did not further improve the level of medication adherence achieved in the original C-STOP study. Importantly, these results can inform adherence in future intervention studies.
在这项上肢骨折后预防骨折的骨质疏松症靶向比较策略（C-STOP）试验的预先计划的变体研究中，我们调查了与C-STOP试验相比，病例管理员（CM）进行的依从性特定指导是否能进一步提高依从率和持续率。
我们对50岁及以上的社区居住成年人进行了一项前瞻性观察队列研究，这些成年人患有上肢骨折且此前未接受过骨质疏松症药物治疗，以评估训练有素的CM是否能与患者合作，提高口服双膦酸盐的依从性和持续性。主要结局是研究入组后12个月时口服双膦酸盐的依从性（服用规定剂量的>80%）。次要结局包括口服双膦酸盐、钙和维生素D补充剂在12个月时的初始依从性以及12个月时的持续性。
研究队列包括84名参与者，其中30人被开了口服双膦酸盐。22人（73.3%）在3个月内开始治疗。12个月时的依从率为77.3%。12个月时的持续率为95.5%。在未被开口服双膦酸盐的人中，62.8%在12个月时服用补充钙，93.0%在服用补充维生素D。抑郁是12个月不依从的显著预测因素（调整后的优势比，9.8；95%置信区间，1.2 - 81.5）。
CM进行的依从性特定指导并未进一步提高原始C-STOP研究中实现的药物依从性水平。重要的是，这些结果可为未来干预研究中的依从性提供参考。
