DETERMINANTS OF ADHERENCE TO OSTEOPOROSIS TREATMENT IN CLINICAL PRACTICE

Mario Barbagallo, Ligia Juliana Dominguez Rodriguez, Luigi Sinigaglia, Giannini, Di Munno, Gerolamo Bianchi, Silvano Adami, Minisola, Maurizio Rossini, Bianchi

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Abstract

Introduction:Poor adherence to prescribedtreatments is widespread in clinical practice and this canlead to potentially life-threatening events. This problem isapparently very common for osteoporosis treatment butthe causes of discontinuation and low compliance arecomplex and poorly defined.Methods:Global adherenceto osteoporosis treatment was specifically addressed in anation-wide survey carried out in 9851 postmenopausalwomen referred to 141 Italian centres for osteoporosis management for a follow-up assessment, at least one yearafter having been prescribed a treatment with one of thefollowing drugs: calcium±vitamin D supplements alone(CaVitD), hormone replacement therapy (HRT), raloxifene60 mg (RLX), intramuscular clodronate 100 mg/7-14 days(CLOD), risedronate 5 mg/day (RIS) and alendronate10mg/daily (ALN10) or 70 mg once weekly (ALN OW).Results:Overall 19.1% of the patients discontinued theprescribed drug before attending the bone mass re-evaluations, more than half of them within the first 6months. The discontinuation rate was significantly differ-ent between the treatments. The medications mostfrequently interrupted within one year were CLOD(28.7%; p<0.01 versus any other treatment), while by farthe least interrupted was ALN-OW (6.9%; p<0.001 versusany other treatment). The most frequent reasons fordiscontinuation were drug related side effects, insufficientmotivation to treatment and fear of side effects. Theprevalence of the reasons for discontinuation weredifferent among treatments: safety concerns were verycommon for HRT, lack of motivation was the mostcommon cause for CaVitD and CLOD, and drug relatedside effects for RIS, ALN and RLX. Persistence totreatment was significantly higher in patients withprevious vertebral fractures, densitometric osteoporosis,on corticosteroid or anti-inflammatory treatments. Asignificantly increased risk of treatment interruption wasfound among patients on benzodiazepine or gastro-protective agents and in patients in whom a bonemeasurement was not readily available. The highestcompliance to recommended dosing was observed withALN OW and HRT (p<0.001 versus any other) and thelowest for CaVitD (p<0.01 versus any other). Poortreatment compliance (<50% drug taken) was significantlyrelated to benzodiazepine and gastroprotective use, while asignificantly better compliance was associated withrecognized risk factors for osteoporosis: early menopause,low bone mass values values, previous vertebral fractures.The poorest adherence was observed when treatmentswere prescribed by General practitioners (GPs), and orthopaedic surgeons (p<0.01 versus global mean).Conclusions:The results of this large survey of Italianosteoporotic women indicates that the most importantdeterminant of both persistence and compliance to treat-ment is the type of drug prescribed with a definiteadvantage of ALN-OW. Treatment compliance is particu-larly poor for CaVitD and this emphasizes the need fornew ways to supplement at least vitamin D. The mainreasons for discontinuation are side effects and lack ofmotivation while the best treatment adherence wasobserved in patients with severe and well documentedosteoporosis
Original languageEnglish
Pages (from-to)914-921
Number of pages8
JournalOsteoporosis International
Volume17
Publication statusPublished - 2006

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism

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    Barbagallo, M., Dominguez Rodriguez, L. J., Sinigaglia, L., Giannini, Di Munno, Bianchi, G., Adami, S., Minisola, Rossini, M., & Bianchi (2006). DETERMINANTS OF ADHERENCE TO OSTEOPOROSIS TREATMENT IN CLINICAL PRACTICE. Osteoporosis International, 17, 914-921.