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A systematic review assessing the effectiveness of interventions to improve persistence with anti-resorptive therapy in women at high risk of clinical fracture

Citation

White, HJW and Bettiol, SS and Perera, R and Roberts, NW and Javaid, MK and Farmer, AJ, A systematic review assessing the effectiveness of interventions to improve persistence with anti-resorptive therapy in women at high risk of clinical fracture, Family Practice, 27, (6) pp. 593-603. ISSN 0263-2136 (2010) [Refereed Article]

Copyright Statement

Copyright 2010 The Author

DOI: doi:10.1093/fampra/cmq060

Abstract

BACKGROUND: despite availability of effective treatments for osteoporosis, impact on fracture rates may be suboptimal because of failure to adhere to recommended anti-resorptive therapy.

OBJECTIVE: to identify randomized controlled trials (RCTs) evaluating interventions intended to improve persistence with anti-resorptive therapy for treating women with osteoporosis or osteopenia. The design of the study is a systematic review and meta-analysis of RCTs.

METHODS: included trials were those reporting interventions to improve persistence with or adherence to anti-resorptive treatment compared to a control medication or usual care. A search of MEDLINE, EMBASE, CINAHL and the Cochrane Library was supplemented by review of cited literature. Reports were reviewed and data pooled where appropriate. The primary outcome was duration of persistence with medication.

RESULTS: six trials met inclusion criteria, including four reporting persistence as an outcome measure indicating a relative reduction in non-persistence of 22% (pooled relative risk: 0.78, 95% confidence interval 0.65-0.95) for active compared to control interventions. Heterogeneity between the trial effects was present but not significant (I(2) = 47%, P = 0.11). Interventions were varied in design, and some measurements of adherence were subject to self-report bias. Two trials included the majority of participants (3386/3497), accounting for >90% of the weight in the pooled estimate.

CONCLUSIONS: trials to date suggest potential for improving persistence with medication taking thus improving treatment outcomes and reducing fracture risk. More precise measurement of medication taking and promoting fidelity to a precisely defined intervention protocol may lead to better assessment of impact on clinically important outcomes.

Item Details

Item Type:Refereed Article
Keywords:Interventions, anti-resorptive therapy, women, clinical fracture
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Primary Health Care
Objective Division:Health
Objective Group:Specific Population Health (excl. Indigenous Health)
Objective Field:Health Related to Ageing
Author:Bettiol, SS (Dr Silvana Bettiol)
ID Code:97029
Year Published:2010
Web of Science® Times Cited:8
Deposited By:Medicine (Discipline)
Deposited On:2014-11-28
Last Modified:2015-06-16
Downloads:0

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