Osteoporosis: 30% of Bisphosphonate Prescriptions Unfilled

Troy Brown

April 22, 2013

Almost 1 in 3 women with osteoporosis failed to pick up new bisphosphonate prescriptions within 60 days of the order date, according to a retrospective cohort study of electronic medical record data from 8454 women seen in a large, integrated, healthcare delivery system.

Kristi Reynolds, PhD, MPH, a research scientist in the Department of Research and Evaluation at Kaiser Permanente Southern California in Pasadena, and colleagues present their findings in an article published online April 18 in Osteoporosis International.

A total of 8454 women aged 55 years or older received new prescriptions between December 1, 2009, and March 31, 2011, and met the inclusion criteria. Primary nonadherence, when a medication is prescribed but never dispensed or picked up, was found among 2497 (29.5%) of those women.

Compared with adherent women, primary nonadherent women used fewer prescription medications, were less likely to be diagnosed with depression, had a lower Charlson Comorbidity Index, and had lower healthcare use (including hospitalizations, hospice visits, home health, skilled nursing facility, and nonhospital visits) in the previous 12 months.

Differences in mean age, median household family income, diagnosis of osteoporosis, or history of fragility fracture were not statistically significant the 2 groups.

In their multivariable analyses, the investigators adjusted for a number of factors including number of prior prescription medications filled, Charlson Comorbidity Index score, prescribing provider specialty, and number of years the provider had been in practice at KPSC. Age and osteoporosis diagnosis were also adjusted for because they were considered clinically important.

After adjustment, older patients or those who used the emergency department in the prior 12 months had a significantly increased odds ratio of primary nonadherence. Patients who had previously used prescription medications or been hospitalized had a lower odds ratio of primary nonadherence.

In unadjusted analyses, the odds ratio of primary nonadherence was lower when prescriptions were written by a provider in internal medicine or rheumatology than when prescriptions were written by a provider in primary care. Primary nonadherence was lower when prescribers had 10 or more years of practice at KPSC. These results were similar after multivariable adjustment.

Kenneth A. Egol, MD, a professor and vice chair in the Department of Orthopaedic Surgery at the Hospital for Joint Diseases, New York University Langone Medical Center in New York City, commented on the study in a telephone interview with Medscape Medical News. Dr. Egol was not involved in the study.

Nonadherence is a common problem with many medications, Dr. Egol noted.

"An important aspect of treating patients is follow-through: educating patients to make sure they understand the benefits of the medications and the procedures and the therapies that we prescribe," Dr. Egol explained.

"Maybe the reason we're not seeing as many complications from this medicine is because not everybody's taking it the way we think they are," Dr. Egol added.

This study was funded by a contractual agreement between Kaiser Permanente Southern California and Amgen Inc in Thousand Oaks, California. Dr. Reynolds and one coauthor received research support from, one coauthor is an employee of and owns stock in, 4 coauthors have served as advisors, and 3 coauthors have served as consultants for Amgen Inc. One coauthor has served as an advisor for Lilly, Novartis, and Pfizer/Wyeth; has served as a consultant for Genentech, Lilly, Novartis, and Pfizer/Wyeth; and has received research support from Lilly and Pfizer/Wyeth. Dr. Egol has disclosed no relevant financial relationships.

Osteoporosis Int. Published online April 18, 2013. Abstract

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