Osteoporosis International

, Volume 22, Issue 1, pp 21-26

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Oral bisphosphonate compliance and persistence: a matter of choice?

  • S. L. SilvermanAffiliated withCedars-Sinai/UCLA/OMC Email author 
  • , J. T. SchousboeAffiliated withDepartment of Rheumatology, Park Nicollet Medical Center
  • , D. T. GoldAffiliated withPsychiatry and Behavioral Sciences, Sociology, and Psychology and Neuroscience, Duke University Medical School


Compliance to oral bisphosphonates is suboptimal, with negative consequences of increased healthcare utilization and less effective fracture risk reduction. Extending dose interval increased adherence only moderately. We used literature derived from multiple chronic conditions to examine the problem of noncompliance with osteoporosis medication. We reviewed the literature on adherence to osteoporosis medication as well as that across multiple chronic conditions to understand what is known about the cause of the poor adherence. Poor compliance to oral medications is due mostly, not to forgetfulness, but to deliberate choice. Gender differences and style of healthcare management also play a role. Preliminary data suggest psychobehavioral interventions may help to improve motivation. We need to understand better reasons for poor compliance before effective interventions can be developed. Forgetfulness is only a small part of poor compliance. Patient preferences must be considered in medication decision making.


Osteoporosis Medication adherence Fractures Bones