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The characteristics of the 27 included studies are given in Table 1. The majority of studies were retrospective database analyses considering adherence in new users of bisphosphonate therapy. Twenty-three (85%) of the studies presented data relating to compliance, while nine (33%) considered persistence. Five (19%) considered both compliance and persistence [14], [23], [http://en.wikipedia.org/wiki/Fluconazole Fluconazole] [24], [25]?and?[26]. The follow-up duration in these studies (where reported) ranged from 40 weeks to 218 weeks, with 10 (37%) studies reporting a follow-up of 2 years or longer. Overall, 698,631 patients were involved in the 27 studies identified: 634,327 patients contributed to the assessment of fracture and compliance and 219,676 patients contributed to the analysis of persistence. [http://www.selleckchem.com/products/Paclitaxel(Taxol).html Paclitaxel purchase] Twenty studies used the MPR to assess compliance and commonly took 80% as the cutoff point at which to define compliant (MPR �� 80%) and noncompliant (MPR [http://www.selleckchem.com/products/bgj398-nvp-bgj398.html BGJ398 molecular weight] and seven within the hazard ratio analysis, constituting data from 101,933 patients. The meta-analyses suggest that noncompliance (vs. compliance) increases the risk of all fractures by 28% (18%�C38%) and 29% (22%�C38%) when using the hazard and odds ratios, respectively (Figs. 3a and 3b). Sensitivity analysis based on study design, population size, publication type, intervention assessed, and ratio adjustment indicated that these variables had minimal effect on the pooled odds ratio, with fracture risk still found to be increased at between 27% and 37% in noncompliant compared to compliant patients (Table 2). In contrast, the skeletal sites considered within these studies do appear to be important: Rabenda et al. [26] contained data potentially suitable for inclusion in the main analyses but considered only hip fractures, while all other studies included in the analysis considered fractures at any location. As a result, this study was not included in the main analysis but was included in sensitivity analysis to determine the effect of fracture location on the pooled result: the inclusion of Rabenda et al. [26] reduced the fracture risk to 24% and increased the statistical heterogeneity within the analysis.