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Osteoporosis International
Published in: Osteoporosis International 4/2008

Open Access 01-04-2008 | Original Article

Loss of treatment benefit due to low compliance with bisphosphonate therapy

Authors: F. J. A. Penning-van Beest, J. A. Erkens, M. Olson, R. M. C. Herings

Published in: Osteoporosis International | Issue 4/2008

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Abstract

Summary

Among 8,822 new female bisphosphonate users, non-compliant bisphosphonate use was associated with a 45% increased risk of osteoporotic fracture compared to compliant use (MPR ≥80%). Classifying compliance into five categories, fracture risk gradually increased with poorer compliance. These results emphasize the importance of treatment compliance in obtaining maximal treatment benefit.

Introduction

Bisphosphonates are widely used to treat osteoporosis and reduce fracture risk. Low compliance is frequent and will limit treatment benefit.

Methods

New female users of alendronate or risedronate between 1999–2004, aged ≥45 years were identified from PHARMO-RLS, including drug-dispensing and hospitalization data of ≥2 million residents of the Netherlands. Patients were followed until first hospitalisation for an osteoporotic fracture, death, or end of study period. Compliance with bisphosphonates during follow-up was measured over 90-day intervals using Medication Possession Ratio (MPR). The association between compliance and fracture risk was analyzed using time-dependent Cox-regression.

Results

The study cohort included 8,822 new female bisphosphonate users, contributing in total 22,484 person-years of follow-up. During follow-up, 176 osteoporotic fractures occurred (excluding the first six months). Non-compliant bisphosphonate use was associated with a 45% increased fracture risk compared to compliant use (MPR ≥80%). Classifying compliance into five categories, fracture risk gradually increased with poorer compliance (p-value <0.05 for trend). A MPR <20% was associated with an 80% increased fracture risk compared to a MPR ≥90%.

Conclusions

These results show a statistically significant association between level of compliance with bisphosphonates and level of fracture risk, emphasizing the importance of treatment compliance in obtaining maximal treatment benefit.
Literature
1.
NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285:785–795CrossRef
2.
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767PubMedCrossRef
3.
McClung MR (2000) Bisphosphonates in osteoporosis: recent clinical experience. Expert Opin Pharmacother 1:225–238PubMedCrossRef
4.
Bone HG, Hosking D, Devogelaer JP, et al. (2004) Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 350:1189–1199PubMedCrossRef
5.
van den Boogaard CHA, Breekveldt- Postma NS, Borggreve SE, et al.(2006) Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study. Curr Med Res Opin 22:1757–1764PubMedCrossRef
6.
Cramer JA, Amonkar MM, Hebborn A, et al. (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 21:1453–1460PubMedCrossRef
7.
McCombs JS, Thiebaud P, McLaughlin-Miley C, et al. (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48:271–287PubMedCrossRef
8.
Penning-van Beest FJA, Goettsch WG, Erkens JA, et al. (2006) Determinants of persistence with bisphosphonates: a study in women with postmenopausal osteoporosis. Clin Ther 28:236–242PubMedCrossRef
9.
Recker RR, Gallagher R, MacCosbe PE (2005) Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 80:856–861PubMed
10.
Baker DE (2002) Alendronate and risedronate: what you need to know about their upper gastrointestinal tract toxicity. Rev Gastroenterol Disord 2:20–33PubMed
11.
Caro JJ, Ishak KJ, Huybrechts KF, et al. (2004) The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 15:1003–1008PubMedCrossRef
12.
Hubbard R, Farrington P, Smith C, et al. (2003) Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Am J Epidemiol 158:77–84PubMedCrossRef
13.
van Staa TP, Leufkens HGM, Cooper C (2002) Utility of medical and drug history in fracture risk prediction among men and women. Bone 31:508–514PubMedCrossRef
14.
Herings RM, Stricker BH, de Boer A, et al. (1995) Benzodiazepines and the risk of falling leading to femur fractures. Dosage more important than elimination half-life. Arch Intern Med 155:1801–1807PubMedCrossRef
15.
Pasco JA, Kotowicz MA, Henry MJ, et al. (2002) Statin use, bone mineral density, and fracture risk: Geelong Osteoporosis Study. Arch Intern Med 162:537–540PubMedCrossRef
16.
Schlienger RG, Kraenzlin ME, Jick SS, et al. (2004) Use of beta-blockers and risk of fractures. JAMA 292:1326–1332PubMedCrossRef
17.
Herings RM, Stricker BH, de Boer A, et al. (1996) Current use of thiazide diuretics and prevention of femur fractures. J Clin Epidemiol 49:115–119PubMedCrossRef
18.
Cranney A, Wells G, Willan A, et al. (2002) Meta-analyses of therapies for postmenopausal osteoporosis. II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 23:508–516PubMedCrossRef
19.
Cranney A, Tugwell P, Adachi J, et al. (2002) Meta-analyses of therapies for postmenopausal osteoporosis. III. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 23:517–523PubMedCrossRef
20.
Siris ES, Harris ST, Rosen CJ, et al. (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022PubMedCrossRef
21.
Weycker D, Macarios D, Edelsberg J, et al. (2007) Compliance with osteoporosis drug therapy and risk of fracture. Osteoporos Int 18:271–277PubMedCrossRef
22.
Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38:922–928.PubMedCrossRef
23.
Gold, DT, Martin BC, Frytak JR, et al. (2007) A claims database analysis of persistence with alendronate therapy and fracture risk in post-menopausal women with osteoporosis. Curr Med Res Opin 23:585–594PubMedCrossRef
24.
Johnell O, Kanis JA, Oden A, et al. (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20:1185–1194PubMedCrossRef
25.
Lo JC, Pressman AR, Omar MA, et al. (2006) Persistence with weekly alendronate therapy among postmenopausal women. Osteoporos Int 17:922–928PubMedCrossRef
26.
Solomon DH, Avorn J, Katz JN, et al. (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419PubMedCrossRef
27.
Emkey R, Koltun W, Beusterien K, et al. (2005) Patient preference for once-monthly ibandronate versus once-weekly alendronate in a randomized, open-label, cross-over trial: the Boniva Alendronate Trial in Osteoporosis (BALTO). Curr Med Res Opin 21:1895–1903PubMedCrossRef
28.
McDonald HP, Garg AX, Haynes RB (2002) Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA 288:2868–2879PubMedCrossRef
Metadata
Title
Loss of treatment benefit due to low compliance with bisphosphonate therapy
Authors
F. J. A. Penning-van Beest
J. A. Erkens
M. Olson
R. M. C. Herings
Publication date
01-04-2008
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 4/2008
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-007-0466-1

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