Table 1.

Healthcare System and Patient Interventions to Improve Adherence to Osteoporosis Medications.

Reference	Study Design	Country	Population	Intervention	Sample size by Intervention / Control	Measurement for Adherence	Results
Stuurman-Bieze et al. 2014 PMID: 24570297	Open-label Clinical Trial with Historical Controls	Holland	Patients starting osteoporosis medications	MeMO program: pharmacist-delivered medication monitoring and counseling	Intervention (N = 495) Historical control (N = 442)	Therapy discontinuation and adherence at 12 months	Intervention: 19.0% discontinued medications or were non-adherent Control: 32.8% discontinued medications or were non-adherent; (p< 0.001)
Ganda et al. 2014 PMID: 24445732	Randomized Controlled Clinical Trial	Australia	Patients over age 45 with symptomatic fragility fractures	“Type A” FLS program in Group A Intervention (6 visits with FLS);	Intervention (N = 49) Control (N = 53)	Medication possession ratio (MPR) at 24 months	Intervention: MPR = 0.78 (IQR, 0.50–0.93) Control: MRP = 0.79 (IQR, 0.48– 0.96); (p=0.68)
Dehamchia-Rehailia et al. 2014 PMID: 24980182	Open-label Clinical Trial	France	Patients with low-trauma fractures	“Type A” FLS program	Intervention (N = 335)	Self-reported medication adherence at 12 and 18 months	Intervention: 74.1% adherent at 12 months; 67.4% adherent at 18 months
Majumdar et al. 2017 PMID: 28275838	Open-label Clinical Trial with a Simulated Control Group	Canada	Patients with low trauma non-hip fractures in the previous 6 weeks	Catch-a-Break: “Type C” FLS program	Intervention (N = 4633) Simulated control (N = 2690)	Bisphosphonate use at 12 months	Intervention: 17.5% (95% CI 15.6–19.4) treated with bisphosphonates Simulated Control: 13.2% (95% CI 12.4–14.0) treated with bisphosphonates; (p < 0.001)
Sewerynek et al. 2013 PMID: 23671440	Non-randomized Controlled Clinical Trial	Poland	Postmenopausal osteoporosis patients on alendronate	Osteoporosis education (Counseling group); patient notification of laboratory results (Biochemical group); phone call to remind about medication (Nurse-assisted group)	Counseling group (N = 29) Biochemical group (N = 31) Nurse-assisted group (N = 31) Control group (N = 32)	Medication Compliance (MPR ≥ 80%) at 12 months	Counseling group: 65.52 ± 9.0% Biochemical group: 64.51 ± 8.7% Nurse-assisted group: 61.29 ± 9.0% Control group: 37.5 ± 8.7%
Tüzün et al. 2013 PMID: 24324365	Randomized Controlled Clinical Trial	Turkey	Postmenopausal women with osteoporosis	Telephone calls, interactive educational sessions, informational booklets	Intervention (N = 226) Control (N = 222)	Self-reported persistence and compliance at 12 months	Intervention: Self-reported persistence and compliance = 152 (50.5) Control: Self-reported persistence and compliance = 149 (49.5); (p = 0.862)
Solomon et al. 2012 PMID: 22371876	Randomized Controlled Clinical Trial	U.S.	Patients starting osteoporosis medications	Telephone-based counseling program by a health educator	Intervention (N = 1046) Control (N = 1041)	Medication possession ratio (MPR) at 12 months	Intervention: MPR = 49% (IQR 7, 88) Control: MPR = 41% (IQR 1.5, 86.0); (p = 0.074)
Nho et al. 2016 PMID: 27294076	Non-randomized Controlled Clinical Trial	Korea	Patients with osteoporosis	Alarm clock	Intervention (N = 50) Control (N = 50)	Medication possession ratio (MPR) at 12 months	Intervention: MPR = 0.80 ± 0.33 Control: MPR = 0.56 ± 0.34; (P<0.001)
Cizmic et al. 2015 PMID: 25956282	Randomized Controlled Clinical Trial	U.S.	Adults with osteoporosis / osteopenia	Interactive voice response phone call followed by a reminder letter to prompt	Intervention (N = 126) Control (N = 118)	Proportion of patients who purchased oral bisphosphonates within 25 days of randomization	Intervention: 48.8% patients purchased their oral bisphosphonates Control: 30.5% patients purchased their oral bisphosphonate
Bianchi et al. 2015 PMID: 25619634	Randomized Controlled Clinical Trial	Italy	Postmenopausal women starting osteoporosis treatment	Educational booklets, calendar, alarm clock (Group 2) Phone call reminders and the materials for Group 2 (Group 3)	Group 2 (N = 110) Group 3 (N = 111) Control (N = 113)	Proportion of patients persistent to treatment (taking the drug for ≥80% of time) at 12 months	Group 2: 90.1% persistent Group 3: 84.6% persistent Control: 92.0% persistent; (p=0.288)

MeMO, Medication Monitoring and Optimization program; MPR, Medication Possession Ratio; PCP, Primary Care Physician.

Patient-directed interventions: Behavioral Interventions using Counseling/Coaching, Interventions using medication reminder prompts

Healthcare system interventions: Pharmacist-directed and Fracture Liaison Service