OBJECTIVE
To quantify the adherence of patients to drug therapy for osteoporosis in real-world
settings via a systematic review and meta-analysis of observational studies.
METHODS
The PubMed and Cochrane databases were searched for English-language observational
studies published from January 1, 1990, to February 15, 2006, that assessed patient
adherence to drug therapy for osteoporosis using the following medical subject headings
and keywords: drug therapy, medication adherence, medication persistence, medication possession
ratio, patient compliance, and osteoporosis. Studies were stratified into 3 groups: persistence (how long a patient continues
therapy), compliance (how correctly, in terms of dose and frequency, a patient takes
the medication), and adherence (a combination of persistence and compliance). A random-effects
model was used to pool results from the selected studies.
RESULTS
Twenty-four studies were included in the meta-analysis. The pooled database-derived
persistence rate was 52% (95% confidence interval [CI], 44%-59%) for treatment lasting
1 to 6 months, 50% (95% CI, 37%-63%) for treatment lasting 7 to 12 months, 42% (95%
CI, 20%-68%) for treatment lasting 13 to 24 months, returning to 52% (95% CI, 45%-58%)
for treatment lasting more than 24 months. Pooled adherence rates decreased from 53%
(95% CI, 52%-54%) for treatment lasting 1 to 6 months to 43% for treatment lasting
7 to 12 months (95% CI, 38%-49%) or 13 to 24 months (43%; 95% CI, 32%-54%). The pooled
refill compliance estimate was 68% (95% CI, 63%-72%) for treatment lasting 7 to 12
months and 68% (95% CI, 67%-69%) for treatment lasting 13 to 24 months. The pooled
self-reported compliance rate was 62% (95% CI, 48%-75%) for treatment lasting 1 to
6 months and 66% (95% CI, 45%-81%) for treatment lasting 7 to 12 months.
CONCLUSION
One-third to half of patients do not take their medication as directed. Nonadherence
occurs shortly after treatment initiation. Terms and definitions need to be standardized
to permit comparability of technologies designed to improve patient adherence. Prospective
trials are needed to assess the relationship between adherence and patient outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Bone Health and Osteoporosis: A Report of the Surgeon General 2004. US Dept of Health and Human Services, Office of the Surgeon General, Rockville, MD2004 (Accessed October 2, 2007.)
- Fast Facts 2006, Washington, DC: National Osteoporosis Foundation.(Accessed November 2, 2007.)
- Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025.J Bone Miner Res. 2007; 22: 465-475
- Meta-analyses of therapies for postmenopausal osteoporosis, IX: summary of meta-analyses of therapies for postmenopausal osteoporosis.Endocr Rev. 2002; 23: 570-578
- Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases.Mayo Clin Proc. 2006; 81: 1013-1022
- Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis.Curr Med Res Opin. 2005; 21: 1453-1460
- Postmenopausal hormonal support: discontinuation of raloxifene versus estrogen.Menopause. 2001; 8: 328-332
- Assessment of compliance with osteoporosis treatment and its consequences in a managed care population.Bone. 2005 Jun; 38 (Epub 2005 Dec 5.): 922-928
- Patient adherence to osteoporosis medications: problems, consequences and management strategies.Drugs Aging. 2007; 24: 37-55
- A systematic review of persistence and compliance with bisphosphonates for osteoporosis.Osteoporos Int. 2007 Aug; 18 (Epub 2007 Feb 17.): 1023-1031
- Persistence with drug therapy: a practical approach using administrative claims data.Manag Care. 2001; 10: 42-45
- Review of adherence to medications for the treatment of osteoporosis.Curr Osteoporos Rep. 2006; 4: 21-27
- Compliance with drug therapy for postmenopausal osteoporosis.Osteoporos Int. 2006; 17 (Epub 2006 Jul 22.): 1645-1652
- Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women.Mayo Clin Proc. 2005; 80: 856-861
- Compliance of osteoporotic patients with different treatment regimens.Isr Med Assoc J. 2003; 5: 859-862
- Determinants of persistence with bisphosphonates: a study in women with postmenopausal osteoporosis.Clin Ther. 2006; 28: 236-242
- Persistence with weekly alendronate therapy among postmenopausal women.Osteoporos Int. 2006; 17 (Epub 2006 Apr 12.): 922-928
- Compliance with osteoporosis medications.Arch Intern Med. 2005; 165: 2414-2419
- Meta-analysis.in: Wixted J Pasher H Stevens' Handbook of Experimental Psychology. Volume 4: Methodology in Experimental Psychology. 3rd ed. Wiley, New York, NY2002: 391-428
- Pamidronate increases bone mineral density in women with postmenopausal or steroid-induced osteoporosis.J Clin Pharm Ther. 2004; 29: 431-436
- A prospective clinical practice intervention to improve osteoporosis management following distal forearm fracture.Osteoporos Int. 2004 Sep; 15 (Epub 2004 Mar 9.): 695-700
- Cyclical intravenous clodronate in postmenopausal osteoporosis: results of a long-term clinical trial.Bone. 1996; 18: 179-184
- Compliance with drug therapies for the treatment and prevention of osteoporosis.Maturitas. 2004; 48: 271-287
- Compliance with hormone replacement therapy (HRT) after screening for post menopausal osteoporosis.Br J Obstet Gynaecol. 1992; 99: 325-328
- Factors affecting long-term adherence to hormone replacement therapy after screening for osteoporosis.Climacteric. 2003; 6: 96-103
- Compliance and satisfaction with raloxifene versus alendronate for the treatment of postmenopausal osteoporosis in clinical practice: an open-label, prospective, nonrandomized, observational study.Clin Ther. 2004; 26: 245-256
- Compliance with pharmacologic therapy for osteoporosis.Osteoporos Int. 2003 Dec; 14 (Epub 2003 Sep 19.): 965-968
- Correlation between patient recall of bone densitometry results and subsequent treatment adherence.Osteoporos Int. 2005 Sep; 16 (Epub 2005 Mar 3.): 1156-1160
- Alendronate increases spine and hip bone mineral density in women with postmenopausal osteoporosis who failed to respond to intermittent cyclical etidronate.Bone. 1999; 24: 65-68
- Tolerability and compliance with risedronate in clinical practice.Osteoporos Int. 2003 May; 14 (Epub Apr 10.): 259-262
- The impact of compliance with osteoporosis therapy on fracture rates in actual practice.Osteoporos Int. 2004 Dec; 15 (Epub 2004 May 27.): 1003-1008
- Osteoporosis intervention in ambulatory patients with previous hip fracture: a multicentric, nationwide Italian survey.Osteoporos Int. 2005; 17 (Epub 2005 Nov 9.): 478-483
- Incidence and causes for failure of treatment of women with proven osteoporosis.Osteoporos Int. 2005 Nov; 16 (Epub 2005 Apr 2.): 1375-1383
- Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database.Osteoporos Int. 2003 Oct; 14 (Epub 2003 Sep 11.): 808-813
- Five years of clinical experience with intermittent cyclical etidronate for postmenopausal osteoporosis.J Rheumatol. 1996; 23: 1560-1564
- Effects of alendronate and calcitonin on bone mineral density in postmenopausal osteoporotic women: an observational study.Pharm World Sci. 2005; 27: 149-153
- Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research.Med Care. 2004; 42: 200-209
- The concordance of self-report with other measures of medication adherence: a summary of the literature.Med Care. 2004; 42: 649-652
- Improving compliance and persistence with bisphosphonate therapy for osteoporosis.Am J Med. 2006; 119: S18-S24
- Medication adherence: a challenge for patients with postmenopausal osteoporosis and other chronic illnesses.J Manag Care Pharm. 2006; 12: S20-S25
- Adherence to medication.N Engl J Med. 2005; 353: 487-497
- Estimating medication persistency using administrative claims data.Am J Manag Care. 2005; 11: 449-457
- Gaps in treatment among users of osteoporosis medications: the dynamics of noncompliance.Am J Med. 2007; 120: 251-256
- Persistence of use of lipid-lowering medications: a cross-national study.JAMA. 1998; 279: 1458-1462
- Medication noncompliance: what is the problem?.Manag Care. 2000; 9: 7-12
- Safety of intravenous and oral bisphosphonates and compliance with dosing regimens.Oncologist. 2004; 9: 28-37
- Drugs and the elderly, part 1: the problems facing managed care.Am J Manag Care. 2000; 6: 1313-1320
- Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study.Curr Med Res Opin. 2006; 22: 1757-1764
- Compliance with osteoporosis drug therapy and risk of fracture.Osteoporos Int. 2007 Mar; 18 (Epub 2006 Oct 5.): 271-277
- Interventions to enhance medication adherence in chronic medical conditions: a systematic review.Arch Intern Med. 2007; 167: 540-550
- Interventions to enhance patient adherence to medication prescriptions: scientific review.JAMA. 2002; 288: 2868-2879
- Cost effectiveness of a pharmacy-based coaching programme to improve adherence to antidepressants.Pharmacoeconomics. 2007; 25: 25-37
- Cost effectiveness of an adherence-improving programme in hypertensive patients.Pharmacoeconomics. 2007; 25: 239-251
- Dangers of using “optimal” cutpoints in the evaluation of prognostic factors.J Natl Cancer Inst. 1994; 86: 829-835
- Outcome-oriented cutpoints in analysis of quantitative exposures.Am J Epidemiol. 1994; 140: 172-184
- Patient- and provider-reported adherence: toward a clinically useful approach to measuring antiretroviral adherence.J Clin Epidemiol. 2001; 54: S91-S98
- The assessment of refill compliance using pharmacy records: methods, validity, and applications.J Clin Epidemiol. 1997; 50: 105-116
Article Info
Footnotes
This project was funded by Amgen Inc, Thousand Oaks, CA. Drs Kothawala and Miller are employees of Cerner LifeSciences, which provides consulting services to clients, including the pharmaceutical industry. Drs Badamgarav and Ryu are employees of Amgen Inc. Dr Halbert provides consulting services to the pharmaceutical industry.
Identification
Copyright
© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.