Skip to main content
SpringerLink
Log in

Persistence with osteoporosis medication among newly-treated osteoporotic patients

  • Original Article
  • Published:
Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Low persistence with osteoporosis medication is associated with higher fracture risk. Previous studies estimated that 1-year persistence with osteoporosis medication is low. Our aim was to study persistence with osteoporosis medication among patients with long-term follow-up (to 5 years). The InterAction Database (IADB) was used to analyze persistence of 8610 Dutch patients initiating osteoporosis drugs between 2003 and 2011. Drugs under study were alendronate, risedronate, ibandronate, etidronate, raloxifene and strontium ranelate. Cumulative persistence rates were calculated after different time frames (3 months–5 years) using survival analysis. Multivariate Cox proportional hazard analyses were used to identify determinants of non-persistence. Furthermore, switching rates of persistent patients who initiated bisphosphonate therapy were analyzed. Persistence with osteoporosis therapy was 70.7 % (95 % CI, 69.7–71.7), 58.5 % (95 % CI, 57.4–59.6 %), 25.3 % (95 % CI, 24.1–26.5) after 6 months, 1 and 5 years, respectively. Determinants associated with higher risk to non-persistence within the first year were daily dosing regimen [HR, 1.76 (95 % CI, 1.46–2.14)], age <60 years [HR, 1.26 (95 % CI, 1.19–1.34)] and use of glucocorticoids [HR, 1.16 (95 % CI, 1.07–1.26)]. Monthly dosing schedule and use of generic brands of alendronate did not show a significant association with non-persistence. Approximately 4.0 % of patients initiating therapy with weekly alendronate or weekly risedronate switched therapy. Persistence with osteoporosis medication is low. Because low persistence is strongly associated with higher fracture risk, interventions to improve persistence are recommended. This study identified several patient groups in whom such interventions may be most relevant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Anonymous (1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94:646–650

    Google Scholar 

  2. Picavet HSJ (2004) Osteoporose en osteoporotische fracturen: omvang en gevolgen. [in Dutch]

  3. Kwaliteitsinstituut voor de gezondheidszorg CBO (2011) Richtlijn Osteoporose en fractuurpreventie derde herziening. Utrecht [in Dutch]

  4. Lips P, van Schoor NM (2005) Quality of life in patients with osteoporosis. Osteoporos Int 16:447–455

    Google Scholar 

  5. National Institute for Health and Clinical Excellence (NICE) (2010) Systematic reviews of clinical effectiveness prepared for the guideline ‘Osteoporosis: assessment of fracture risk and the prevention of osteoporotic fractures in individuals at high risk’. 2008

  6. Ross S, Samuels E, Gairy K, Iqbal S, Badamgarav E, Siris E (2011) A meta-analysis of osteoporotic fracture risk with medication nonadherence. Value Health 14:571–581

    Article  PubMed  Google Scholar 

  7. Hiligsmann M, Rabenda V, Bruyère O, Reginster J (2010) The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients. Health Policy 96:170–177

    Article  PubMed  Google Scholar 

  8. Penning-van Beest FJA, Goettsch WG, Erkens JA, Herings RMC (2006) Determinants of persistence with bisphosphonates: a study in women with postmenopausal osteoporosis. Clin Ther 28:236–242

    Article  PubMed  CAS  Google Scholar 

  9. Netelenbos JC, Geusens PP, Ypma G, Buijs SJE (2011) Adherence and profile of non-persistence in patients treated for osteoporosis–a large-scale, long-term retrospective study in The Netherlands. Osteoporos Int 22:1537–1546

    Article  PubMed  CAS  Google Scholar 

  10. van den Boogaard CHA, Breekveldt-Postma N, Borggreve SE, Goettsch WG, Herings RMC (2006) Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis study. Curr Med Res Opin 22:1757–1764

    Article  PubMed  Google Scholar 

  11. Stuurman A, Hiddink E (2010) Pharmaceutical care interventions, initiated by computerized drug prescription monitoring, improve drug compliance [article in Dutch]. PW Wetenschappelijk Platform 4:128–135

    Google Scholar 

  12. Leufkens HG, Urquhart J (2006, 2007) Automated Pharmacy Record Linkage in The Netherlands. In: Anonymous (eds) Pharmacoepidemiology. Wiley, New York, pp 311–322

  13. Tobi H, van den Berg P, de Jong-van den Berg L (2000) The InterAction Database: synergy of science and practice in pharmacy. In: Brause R, Hanisch E (eds) Medical data analysis. Springer, Berlin, pp 93–108

  14. Schirm E, Monster TB, de Vries R, van den Berg PB, de Jong-van den Berg LT, Tobi H (2004) How to estimate the population that is covered by community pharmacies? An evaluation of two methods using drug utilisation information. Pharmacoepidemiol Drug Saf 13:173–179

  15. Vegter S, Nguyen NH, Visser ST, de Jong-van den Berg LT, Postma MJ, Boersma C (2011) Compliance, persistence, and switching patterns for ACE inhibitors and ARBs. Am J Manag Care 17:609–616

  16. Li L, Roddam A, Gitlin M, Taylor A, Shepherd S, Shearer A, Jick S (2012) Persistence with osteoporosis medications among postmenopausal women in the UK General Practice Research Database. Menopause 19:33–40

    Article  PubMed  Google Scholar 

  17. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11:44–47

    Article  PubMed  Google Scholar 

  18. Rabenda V, Hiligsmann M, Reginster JY (2009) Poor adherence to oral bisphosphonate treatment and its consequences: a review of the evidence. Expert Opin Pharmacother 10:2303–2315

    Article  PubMed  CAS  Google Scholar 

  19. Catalan VS, LeLorier J (2000) Predictors of long-term persistence on statins in a subsidized clinical population. Value Health 3:417–426

    Article  PubMed  CAS  Google Scholar 

  20. Landfeldt E, Strom O, Robbins S, Borgstrom F (2012) Adherence to treatment of primary osteoporosis and its association to fractures–the Swedish Adherence Register Analysis (SARA). Osteoporos Int 23:433–443

    Article  PubMed  CAS  Google Scholar 

  21. Cotte FE, Fardellone P, Mercier F, Gaudin AF, Roux C (2010) Adherence to monthly and weekly oral bisphosphonates in women with osteoporosis. Osteoporos Int 21:145–155

    Article  PubMed  CAS  Google Scholar 

  22. Cooper A, Drake J, Brankin E, PERSIST Investigators (2006) Treatment persistence with once-monthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study. Int J Clin Pract 60:896–905

    Google Scholar 

  23. Weiss TW, Henderson SC, McHorney CA, Cramer JA (2007) Persistence across weekly and monthly bisphosphonates: analysis of US retail pharmacy prescription refills. Curr Med Res Opin 23:2193–2203

    Article  PubMed  Google Scholar 

  24. Sheehy O, Kindundu CM, Barbeau M, LeLorier J (2009) Differences in persistence among different weekly oral bisphosphonate medications. Osteoporos Int 20:1369–1376

    Article  PubMed  CAS  Google Scholar 

  25. Ringe JD, Moller G (2009) Differences in persistence, safety and efficacy of generic and original branded once weekly bisphosphonates in patients with postmenopausal osteoporosis: 1-year results of a retrospective patient chart review analysis. Rheumatol Int 30:213–221

    Article  PubMed  CAS  Google Scholar 

  26. Strom O, Landfeldt E (2012) The association between automatic generic substitution and treatment persistence with oral bisphosphonates. Osteoporos Int 23:2201–2209

    Article  PubMed  CAS  Google Scholar 

  27. EMEA (2007) EMEA recommends changes in the product information for Protelos/Osseor due to the risk of severe hypersensitivity reactions

  28. Rossini M, Bianchi G, Di Munno O, Giannini S, Minisola S, Sinigaglia L, Adami S, Treatment of Osteoporosis in clinical Practice (TOP) Study Group (2006) Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 17:914–921

    Article  PubMed  CAS  Google Scholar 

  29. Landfeldt E, Lang A, Robbins S, Strom O (2011) Gastrointestinal tolerability and patterns of switching in patients treated for primary osteoporosis: the Swedish Adherence Register Analysis (SARA). Calcif Tissue Int 89:234–245

    Article  PubMed  CAS  Google Scholar 

  30. (2012) Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid. RIVM, Bilthoven

  31. Enlund H (1982) Measuring patient compliance in antihypertensive therapy–some methodological aspects. J Clin Hosp Pharm 7:43–51

    PubMed  CAS  Google Scholar 

  32. Grymonpre R, Cheang M, Fraser M, Metge C, Sitar DS (2006) Validity of a prescription claims database to estimate medication adherence in older persons. Med Care 44:471–477

    Article  PubMed  Google Scholar 

  33. Gleeson T, Iversen MD, Avorn J, Brookhart AM, Katz JN, Losina E, May F, Patrick AR, Shrank WH, Solomon DH (2009) Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review. Osteoporos Int 20:2127–2134

    Article  PubMed  CAS  Google Scholar 

  34. Van Boven JFM, Hiddink EG, Stuurman-Bieze AGG, Postma MJ, Vegter S (2011) Structured medication surveillance for improving adherence to bisphosphonate therapy offers perspectives for cost-effective pharmaceutical care [article in Dutch]. PW Wetenschappelijk Platform 5:160–166

    Google Scholar 

Download references

Acknowledgments

This study was funded by a research grant from GlaxoSmithKline.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands

    Job F. M. van Boven, Pieter T. de Boer, Maarten J. Postma & Stefan Vegter

Authors
  1. Job F. M. van Boven
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pieter T. de Boer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maarten J. Postma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Vegter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Job F. M. van Boven.

About this article

Cite this article

van Boven, J.F.M., de Boer, P.T., Postma, M.J. et al. Persistence with osteoporosis medication among newly-treated osteoporotic patients. J Bone Miner Metab 31, 562–570 (2013). https://doi.org/10.1007/s00774-013-0440-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00774-013-0440-2

Keywords

Search

Navigation