***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Summary Using a protocol led intervention program , pharmacists can decrease nonadherence to osteoporosis medication , by continuous monitoring and tailored counseling sessions , starting at treatment initiation . In the usual care group , 32.8 % of patients initiating osteoporosis medication discontinued or were nonadherent , compared to 19.0 % of patients in the intervention group . Purpose While community pharmacies have been shown to offer a promising platform for osteoporosis management in patients with osteoporosis , more research is needed to determine pharmacists ’ effects on improving adherence . The aim of this study was to determine the effects of a community pharmacists ’ intervention program on the 1-year discontinuation and nonadherence rates of patients initiating osteoporosis medication . Methods This intervention study included 937 patients , recruited from 13 Dutch community pharmacies , initiating osteoporosis medication . The intervention group ( N = 495 ) , received the Medication Monitoring and Optimization ( MeMO ) intervention , comprising of continuous monitoring of patients ’ adherence to their osteoporosis medication and tailored counseling sessions with nonadherent patients . Results were compared to an internal ( n = 442 ) reference group , receiving usual pharmacy care . Primary study outcomes were therapy discontinuation and nonadherence ; results were adjusted for potential confounders using Cox proportional hazard analysis . Secondary outcome was patients ’ satisfaction . Results In the usual care group , 32.8 % of patients initiating osteoporosis medication discontinued or were nonadherent , compared to 19.0 % of patients in the intervention group ( P < 0.001 ) . Ninety-three percent of the respondents were satisfied with the pharmacies ’ services provided . Notably , 31 % mentioned that the pharmacy was the only place where they received information on various aspects of administration and acting of their medication . Conclusion Pharmacists can decrease nonadherence and discontinuation with osteoporosis medication by providing tailored counseling sessions and continuous monitoring of drug use . Pharmaceutical care programs , such as MeMO , contribute to more optimal use of osteoporosis medication Osteoporosis treatment rates are declining , even among those with past fractures . Novel , low-cost approaches are needed to improve osteoporosis care . We conducted a parallel group , controlled , r and omized clinical trial evaluating a behavioral intervention for improving osteoporosis medication use . A total of 2684 women with self-reported fracture history after age 45 years not using osteoporosis therapy from US Global Longitudinal Study of Osteoporosis in Women ( GLOW ) sites were r and omized 1:1 to receive a multimodal , tailored , direct-to-patient , video intervention versus usual care . The primary study outcome was self-report of osteoporosis medication use at 6 months . Other outcomes included  calcium and vitamin D supplementation , bone mineral density ( BMD ) testing , readiness for behavioral change , and barriers to treatment . In intent-to-treat analyses , there were no significant differences between groups ( intervention versus control ) in osteoporosis medication use ( 11.7 % versus 11.4 % , p = 0.8 ) , calcium supplementation ( 31.8 % versus 32.6 % , p = 0.7 ) , vitamin D intake ( 41.3 % versus 41.9 % , p = 0.8 ) , or BMD testing ( 61.8 % versus 57.1 % , p = 0.2 ) . In the intervention group , fewer women were in the precontemplative stage of behavior change , more women reported seeing their primary care provider , had concerns regarding osteonecrosis of the jaw , and difficulty in taking/remembering to take osteoporosis medications . We found differences in BMD testing among the subgroup of women with no prior osteoporosis treatment , those who provided contact information , and those with no past BMD testing . In per protocol analyses , women with appreciable exposure to the online intervention ( n = 257 ) were more likely to start nonbisphosphonates  ( odds ratio [ OR ] = 2.70 ; 95 % confidence interval [ CI ] 1.26 - 5.79 ) compared with the usual care group . Although our intervention did not increase the use of osteoporosis therapy at 6 months , it increased nonbisphosphonate medication use and BMD testing in select subgroups , shifted participants ' readiness for behavior change , and altered perceptions of barriers to osteoporosis treatment . Achieving changes in osteoporosis care using patient activation approaches alone is challenging . © 2018 American Society for Bone and Mineral Research Summary Telephone call intervention did not improve alendronate persistence in Fracture Liaison Service ( FLS ) patients in this study . A bone turnover marker cut-off point for alendronate persistence is proposed for individual FLS patients . Introduction FLS aims to prevent subsequent fractures , which should include improving patients ’ persistence with prescribed oral bisphosphonates . We studied the influence of telephone calls and the predictive value of changes in bone turnover markers ( BTMs ) for evaluating persistence with alendronate . Methods Postmenopausal women with a recent fracture and osteoporosis who started alendronate  were r and omized to receive three phone calls ( PC ) ( after 1 , 4 , and 12 months ) or no phone calls ( no PC ) . s-CTX and P1NP  were measured at baseline and after 3 , 6 , 9 , and 12 months . As a reference group , 30 postmenopausal osteopenic patients with a recent fracture were analyzed as well . Persistence was assessed using the Dutch National Switch Point Pharmacies-GPs data base and cross-referenced with PC , no PC , and BTM changes . Cut-off values of BTMs were calculated based on least significant change ( LSC ) and also on underrunning median values of the untreated osteopenic postmenopausal reference group with a recent fracture . Results Out of 119 patients , 93 ( 78 % ) completed 12 months follow-up ( 45 PC and 48 no PC ) . Mean age was 69 years . Persistence was similar in PC and no PC participants . The cut-off value > 29 % ( < 415 ng/L ) as LSC of s-CTX and > 36 % ( < 53.1 μg/L ) as LSC of P1NP was determined optimally showing alendronate persistence after 1 year ( being 93 and 88 % , respectively ) . Conclusions In this context , telephone calls did not improve persistence . In around 90 % of patients , 1-year alendronate persistence was confirmed by achieving LSC of s-CTX and of P1NP at 12 months Summary Patients often do not know or underst and their bone density test results , and pharmacological treatment rates are low . In a clinical trial of 7749 patients , we used a tailored patient-activation result letter accompanied by a bone health brochure to improve appropriate pharmacological treatment . Treatment rates , however , did not improve . Introduction Patients often do not know or underst and their dual-energy x-ray absorptiometry ( DXA ) test results , which may lead to suboptimal care . We tested whether usual care augmented by a tailored patient-activation DXA result letter accompanied by an educational brochure would improve guideline -concordant pharmacological treatment compared to usual care only . Methods We conducted a r and omized , controlled , double-blinded , pragmatic clinical trial at three health care centers in the USA . We r and omized 7749 patients ≥50 years old and presenting for DXA between February 2012 and August 2014 . The primary clinical endpoint at 12 and 52 weeks post-DXA was receiving guideline -concordant pharmacological treatment . We also examined four of the steps along the pathway from DXA testing to that clinical endpoint , including ( 1 ) receiving and ( 2 ) underst and ing their DXA results and ( 3 ) having subsequent contact with their provider and ( 4 ) discussing their results and options . Results Mean age was 66.6 years , 83.8 % were women , and 75.3 % were non-Hispanic whites . Intention-to-treat analyses revealed that guideline -concordant pharmacological treatment was not improved at either 12 weeks ( 65.1 vs. 64.3 % , p = 0.506 ) or 52 weeks ( 65.2 vs. 63.8 % , p = 0.250 ) post-DXA , even though patients in the intervention group were more likely ( all p < 0.001 ) to recall receiving their DXA results letter at 12 weeks , correctly identify their results at 12 and 52 weeks , have contact with their provider at 52 weeks , and have discussed their results with their provider at 12 and 52 weeks . Conclusion A tailored DXA result letter and educational brochure failed to improve guideline -concordant care in patients who received DXA The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . Objective . To evaluate 2 incremental levels of intervention design ed to increase initiation of osteoporosis treatment by primary care physicians ( PCP ) following fragility fractures ( FF ) . Methods . Women and men over age 50 years were screened for incident FF in fracture clinics , and eligible out patients were r and omly assigned to st and ard care ( SC ) or to either minimal ( MIN ) or intensive ( INT ) interventions . The MIN and INT interventions were intended to educate and motivate both patients and PCP , but differed in their frequency of contact and information content . Delivery of osteoporosis medication was confirmed with pharmacists .  Treatment rates were analyzed using an intention-to-treat approach . Results . At inclusion , 74.3 % of 881 out patients with FF were untreated . Followup at 12 months was completed in 92.3 % of patients . Up to 90 % of patients treated at inclusion remained treated at 12 months . Among patients who initially were untreated , 18.8 % in the SC group , 40.4 % in the MIN , and 53.2 % in the INT groups were treated at 12 months . Change in treatment rates ( adjusted for age and initial treatment ) increased significantly after both MIN and INT . Only the INT intervention significantly increased treatment rates in patients with previous fractures . Negative predictors of change in treatment status included non-major FF , age younger than 65 years , and male sex . Conclusion . Both interventions significantly increased initiation of osteoporosis treatment . Our multidisciplinary intervention builds on existing first-line structures and uses minimal specialized re sources . Iterative and systematic interventions in the context of clinical care may modify the approach of PCP to osteoporosis management after FF and narrow the care gap in the long term Summary Following initiation of oral bisphosphonate therapy through a secondary fracture prevention program , 2-year treatment compliance and persistence remained high and were similar in patients r and omised to follow-up by either the program or primary care physician . Thus , community-based and specialist management are equally effective in supporting compliance and persistence with anti-osteoporotic treatments . Introduction The purpose of this study was to determine whether management by a secondary fracture prevention ( SFP ) program ( aka “ fracture liaison service ” ) results in better compliance and persistence to oral bisphosphonate therapy than follow-up by the primary care physician , after initiation within an SFP program . Methods This prospect i ve RCT included 102 patients with incident osteoporotic fractures referred to a SFP program in Sydney , Australia . Following oral bisphosphonate therapy initiation , patients were r and omised to either 6-monthly follow-up with the SFP program ( group A ) or referral to their primary care physician with a single SFP program visit at 24 months ( group B ) . Compliance and persistence to treatment were measured using pharmaceutical cl aims data . Predictors of compliance and persistence and associations between compliance and persistence , and changes in bone mineral density ( BMD ) or bone resorption marker , urinary deoxypyridinoline over 24 months were analysed . Results The median medication possession ratio at 24 months was 0.78 ( IQR , 0.50–0.93 ) in group A and 0.79 ( IQR , 0.48–0.96 ) in group B ( p = 0.68 ) . Persistence at 24 months was also similar in both groups ( 64 vs. 61 % , respectively ; p = 0.75 ) . After adjusting for confounders , patients in group A were not more likely to be compliant ( OR , 1.06 ; 95 % CI , 0.46–2.47 ) or persistent ( HR , 0.83 ; 95 % CI , 0.27–1.67 ) than those r and omised to group B. Time-based changes in BMD or bone turnover were not associated with compliance or persistence . Conclusion Compliance and persistence to oral bisphosphonate therapy remain high amongst patients initiated within an SFP program , with community-based and SFP program management being equally effective in maintaining therapeutic compliance and persistence over 2 years . These results indicate that one of the main functions of an SFP program may be the initiation of therapy rather than continuous patient monitoring Purpose Osteoporosis Choice , an encounter decision aid , can engage patients and clinicians in shared decision making about osteoporosis treatment . Its effectiveness compared to the routine provision to clin 
    Output:
    
In most subtypes of interventions , mixed results on adherence ( and persistence ) were found .
Multicomponent interventions based on patient education and counseling were the most effective interventions when aim ing to increase adherence and /or persistence to osteoporosis medications .
This up date d review suggests that patient education , monitoring and supervision , change in drug regimen , and interdisciplinary collaboration have mixed results on medication adherence and persistence , with more positive effects for multicomponent interventions with active patient involvement .
Compared with the previous review , a shift towards more patient involvement , counseling and shared decision-making , was seen , suggesting that individualized solutions , based on collaboration between the patient and the healthcare provider , are needed to improve adherence and persistence to osteoporosis medications