Overcoming Problems with Adherence to Osteoporosis Medication

Véronique Rabenda; Jean-Yves Reginster


Expert Rev Pharmacoeconomics Outcomes Res. 2010;10(6):677-689. 

In This Article

Abstract and Introduction


Nonadherence to pharmacological treatment in osteoporosis is a well-recognized problem. As in other chronic diseases, adherence to osteoporosis treatment is poor, resulting in enormous burden on patients and healthcare resources. Most importantly, low adherence rates consistently result in increased rates of fractures. However, it seems that efforts to evaluate and improve rates of both compliance and persistence are increasing. The extension of dosing intervals may be an element, among others, allowing improvements in therapeutic adherence. Improved patient education, enhancing healthcare provider–patients interaction, taking into account patient's preferences and involving them in treatment decisions may improve adherence.


Over the past 20 years, increasing importance has been placed on treatment adherence, with poor adherence having been identified as a critical factor in population health. Adherence is a common phenomenon that results in treatment failures, increased morbidity and mortality, and enormous burden to society and the economy.[1] The term 'adherence' is a concept that, generally, includes the notions of both compliance and persistence.[2,3] Compliance reflects the extent to which the patient takes the medication in accordance with the prescribed dose and interval use as specified in the official product information. Compliance is often assessed using the medication possession ratio (MPR) by dividing the sum of all days of the drugs supply received during the 1-year study period by 365 potential days of therapy. Persistence is defined as the accumulation of time from initiation to discontinuation of therapy.

In recent years there has been an explosion in the development of new drugs for the treatment of osteoporosis. Pharmacological interventions approved in the USA and/or the EU for the treatment and/or prevention of osteoporosis in postmenopausal women include bisphosphonates (e.g., etidronate, ibandronate, alendronate, risedronate and zoledronic acid), selective estrogen receptor modulators (raloxifene, bazedoxifene and lasofoxifene), strontium ranelate, parathyroid hormone (PTH 1–84), teriparatide (recombinant 1–34 human PTH), calcitonin, denosumab (a RANKL-specific recombinant humanized monoclonal antibody) and estrogen/hormone-replacement therapy. Oral bisphosphonates are currently the most-widely prescribed osteoporotic drugs. Clinical trials demonstrated that such treatment significantly reduces the incidence of both vertebral and nonvertebral fractures.[4–8]

Despite the availability of effective, well-tolerated drugs for osteoporosis, adherence is suboptimal. However, it seems that efforts to improve adherence to osteoporosis treatments are ongoing.


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