Bone Turnover Markers May Help Detect Patient Adherence to Osteoporosis Treatment

Lauren Santye, Assistant Editor
Published Online: Tuesday, January 31st, 2017
Investigators may have found a feasible and practical way to identify low adherence to oral bisphosphonates in patients with osteoporosis.

Although osteoporosis is commonly treated with oral bisphosphonates, approximately half of patients who initiate treatment either do not follow their treatment regimen or discontinue treatment within 1 year. This low adherence is a frequent problem among patients, and it jeopardizes the treatments efficacy.

The International Osteoporosis Foundation and the European Calcified Tissue Society convened a working group to propose a screening strategy that could detect a lack of adherence to bisphosphonates.

In a paper published in Osteoporosis International, investigators sought to determine whether bone turnover markers (BTMs) could identify low adherence in patients with postmenopausal osteoporosis who are initiating oral bisphosphonates for the treatment of osteoporosis.

BTMs can reflect the drug’s early effects on bone tissue. If there is a low response observed shortly after treatment has begun, it could indicate either low adherence or underlying causes of impaired response to medication.

Based on the study’s findings, the working group recommends that the BTMs procollagen type 1 N-terminal propeptide (PINP) and collagen type 1 C-terminal telopeptide (CTX) levels be measured at baseline and again at 3 months after starting therapy, to check for a decrease above the least significant change (decrease of more than 38% for PINP and 56% for CTX).

The detection rate for the measurement of PINP is 84%, and 87% for CTX. If the variation in at least 1 is considered when measuring both, the level of detection is 94.5%.

In individuals who have a decrease in both PINP and CTX that does not exceed the least significant change (38% and 56%, respectively) assessment of adherence, or investigation of secondary osteoporosis, should be carried out.

“The use of bone turnover marker measurement to detect a lack of response to oral bisphosphonates is a practical and low-cost screening procedure which helps identify potential non-adherence in patients very early after treatment initiation,” said Adolfo Diez-Perez, co-chair of the working group. “The patients benefit as this opens up opportunity for discussion and early intervention with noncompliant patients, or can indicate that secondary causes of osteoporosis need to be assessed.”

The authors concluded that if a significant decrease is observed, the treatment can continue, but if no decrease occurs, the clinician should reassess to identify problems with the treatment, mainly low adherence.

“It will be interesting to further evaluate if these recommendations have an impact on adherence in a real-life setting,” said Richard Eastell, co-chair of the working group.

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