Determinants of adherence to osteoporosis treatment in clinical practice View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2006-03-15

AUTHORS

M. Rossini, G. Bianchi, O. Di Munno, S. Giannini, S. Minisola, L. Sinigaglia, S. Adami

ABSTRACT

IntroductionPoor adherence to prescribed treatments is widespread in clinical practice and this can lead to potentially life-threatening events. This problem is apparently very common for osteoporosis treatment but the causes of discontinuation and low compliance are complex and poorly defined.MethodsGlobal adherence to osteoporosis treatment was specifically addressed in a nation-wide survey carried out in 9851 postmenopausal women referred to 141 Italian centres for osteoporosis management for a follow-up assessment, at least one year after having been prescribed a treatment with one of the following drugs: calcium±vitamin D supplements alone (CaVitD), hormone replacement therapy (HRT), raloxifene 60 mg (RLX), intramuscular clodronate 100 mg/7-14 days (CLOD), risedronate 5 mg/day (RIS) and alendronate 10mg/daily (ALN10) or 70 mg once weekly (ALN OW).ResultsOverall 19.1% of the patients discontinued the prescribed drug before attending the bone mass re-evaluations, more than half of them within the first 6 months. The discontinuation rate was significantly different between the treatments. The medications most frequently interrupted within one year were CLOD (28.7%; p<0.01 versus any other treatment), while by far the least interrupted was ALN-OW (6.9%; p<0.001 versus any other treatment). The most frequent reasons for discontinuation were drug related side effects, insufficient motivation to treatment and fear of side effects. The prevalence of the reasons for discontinuation were different among treatments: safety concerns were very common for HRT, lack of motivation was the most common cause for CaVitD and CLOD, and drug related side effects for RIS, ALN and RLX. Persistence to treatment was significantly higher in patients with previous vertebral fractures, densitometric osteoporosis, on corticosteroid or anti-inflammatory treatments. A significantly increased risk of treatment interruption was found among patients on benzodiazepine or gastro-protective agents and in patients in whom a bone measurement was not readily available. The highest compliance to recommended dosing was observed with ALN OW and HRT (p<0.001 versus any other) and the lowest for CaVitD (p<0.01 versus any other). Poor treatment compliance (<50% drug taken) was significantly related to benzodiazepine and gastroprotective use, while a significantly better compliance was associated with recognized risk factors for osteoporosis: early menopause, low bone mass values values, previous vertebral fractures. The poorest adherence was observed when treatments were prescribed by General practitioners (GPs), and orthopaedic surgeons (p<0.01 versus global mean).ConclusionsThe results of this large survey of Italian osteoporotic women indicates that the most important determinant of both persistence and compliance to treatment is the type of drug prescribed with a definite advantage of ALN-OW. Treatment compliance is particularly poor for CaVitD and this emphasizes the need for new ways to supplement at least vitamin D. The main reasons for discontinuation are side effects and lack of motivation while the best treatment adherence was observed in patients with severe and well documented osteoporosis. More... »

PAGES

914-921

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00198-006-0073-6

DOI

http://dx.doi.org/10.1007/s00198-006-0073-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1020337646

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/16538553


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95 low bone mass values values
96 low compliance
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99 mass
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101 measurements
102 medications
103 menopause
104 mg/7
105 months
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111 osteoporosis
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114 osteoporotic women
115 patients
116 persistence
117 poor adherence
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119 postmenopausal women
120 practice
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122 prescribed drugs
123 prescribed treatment
124 prevalence
125 previous vertebral fracture
126 problem
127 rate
128 reasons
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130 results
131 risedronate
132 risk
133 risk factors
134 safety concerns
135 side effects
136 supplements
137 surgeons
138 survey
139 therapy
140 treatment
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142 treatment compliance
143 treatment interruption
144 types
145 types of drugs
146 use
147 value value
148 values
149 vertebral fractures
150 vitamin D.
151 way
152 women
153 years
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