Randomised controlled trials (RCTs) that compared interventions aimed at improving persistence with or adherence to anti-resorptive therapy versus interventions with standard care for women with a high risk of clinical fracture were eligible for inclusion. Trials of educational or motivational interventions, where patients did not adhere with treatment were excluded.
The primary outcome was duration of persistence with medication. Secondary outcomes were different measures of adherence such as rate of fragility fracture, bone mass density and measurement of bone turnover markers.
Interventions in the included trials included biomarker monitoring with feedback to patients or other motivational interventions including educational leaflets, nurse-led education, decision aids and telephone reminders. Only postmenopausal women were included in the trials, but risk factors varied, as did measurement or assessment of risk factors. Participants were prescribed risedronate, alendronate with ibandronate, or raloxifene. Included trials were conducted in Australia, North and South America, Europe and Africa.
Two reviewers independently selected studies for inclusion.