Poor adherence to medication is associated with adverse effects on outcomes in osteoporosis or osteopenia, and nonadherent patients have lower decreases in rates of bone turnover, smaller gains in BMD, and a significantly higher risk of fracture. According to an analysis of a community cohort of postmenopausal women at risk, the fracture risk for patients who received a bisphosphonate did not differ significantly from patients who did not receive a bisphosphonate.