Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis.

Agency for Health Technologies Assessment, Instituto de Salud Carlos III. Science and Innovation Ministry, 5 Monforte de Lemos, Madrid, 28029, Spain.
Osteoporosis International (Impact Factor: 4.04). 12/2009; 21(11):1943-51. DOI: 10.1007/s00198-009-1134-4
Source: PubMed

ABSTRACT Systematic review of adherence to bisphosphonates for the treatment of osteoporosis finds suboptimal levels of persistence and compliance. Poor bisphosphonate compliance increases fracture risk.
The objectives of the study were to measure the persistence and compliance with bisphosphonates for the treatment of osteoporotic patients, and to estimate the influence of compliance on fracture risk.
A systematic review of bisphosphonate adherence in clinical practise provided new evidence to perform a meta-analysis of the means of bisphosphonate persistence and compliance, with a subsequent meta-analysis of fracture risk comparing poorly versus highly compliant patients.
Fifteen articles, totalling 704,134 patients, met our inclusion criteria. Most of the patients were postmenopausal women treated with bisphosphonates. The 3.95% of the patients received hormone replacement therapy, but the rest received bisphosphonates. The meta-analysis of five articles totalling 236,540 patients, who were followed for 1 year, provided a pooled persistence mean of 184.09 days. The meta-analysis of five articles, totalling 234,737 patients, who were also followed for 1 year, provided a pooled medication possession ratio mean of 66.93%. The meta-analysis of six articles, totalling 171,063 patients, who were followed for varying periods of time between 1 and 2.5 years, provided a pooled 46% increased fracture risk in non-compliant patients versus compliant patients. The increased fracture risk was lower for non-vertebral (16%) and hip (28%) than for clinical vertebral fractures (43%).
Persistence and compliance are suboptimal for postmenopausal women undergoing bisphosphonate therapy for osteoporosis. The clinical consequence of this low compliance is an increased risk of fracture, which is lower for non-vertebral than for clinical vertebral fractures.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Since low adherence to a long-term therapy results in a poor clinical outcome and significantly increases healthcare costs, adherence to the treatment of chronic disorders is an issue of great interest. This is particularly true of the treatment of osteoporosis (OP).
    05/2014; 11(2):123-5.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Advances in biomedical technology and access to effective medications have resulted in significant improvements in patient survival and quality of life. Patient adherence is crucial to quality healthcare outcomes; however, achievement of consistent adherence remains difficult. Patient nonadherence represents an important health problem, from a clinical/economic viewpoint, being associated with reduced treatment benefits and significant financial burden. Non-adherence potentially leads to adverse drug events (ADEs), which are generally responsible for poorer health outcomes and avoidable resource misuse. Further, adverse drug reactions (ADRs) exemplify one of the most significant barriers to patients’ medication-taking behavior with further detrimental clinical/economic outcomes. Areas covered: The authors review adherence definitions and its measurement, emphasizing the consequences of the New European Pharmacovigilance Legislation on ADR definition. They analyzed the causes and the clinical/economic consequences of non-adherence and ADEs/ADRs in order to highlight a possible causal link. Expert opinion: Careful assessment of this harmful relationship is crucial in planning for the interventions needed to improve effectiveness of pharmacological care and to safeguard the sustainability of healthcare systems. Finally, through the ‘deactivation’ of this link, there will be more chance that advances in healthcare technologies will realize their potential to reduce the burden of chronic illness.
    Expert Opinion on Drug Safety 08/2014; 13(Suppl. 1):S41-S55. · 2.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This 7-year prospective observational study determined the predictors of re-fracture amongst 234 patients managed within a Secondary Fracture Prevention programme. Poor compliance, multiple co-morbidities, corticosteroid therapy, low hip bone mineral density (BMD) or low body weight were all significantly associated with re-fracture in patients commenced on long-term anti-resorptive therapy.
    Osteoporosis International 09/2014; · 4.17 Impact Factor


Available from
Jun 10, 2014