Osteoporosis International

, Volume 23, Issue 1, pp 223–231

GRAND: the German retrospective cohort analysis on compliance and persistence and the associated risk of fractures in osteoporotic women treated with oral bisphosphonates

  • P. Hadji
  • V. Claus
  • V. Ziller
  • M. Intorcia
  • K. Kostev
  • T. Steinle
Original Article

DOI: 10.1007/s00198-011-1535-z

Cite this article as:
Hadji, P., Claus, V., Ziller, V. et al. Osteoporos Int (2012) 23: 223. doi:10.1007/s00198-011-1535-z



This database analysis of over 4,000 German women prescribed oral bisphosphonates between December 2004 and November 2007 showed that compliance and persistence with oral bisphosphonates in German women with osteoporosis were inadequate.


GRAND is a database analysis designed to investigate persistence and compliance with oral bisphosphonate regimens, and their association with fracture incidence, in women with osteoporosis.


Diagnostic, treatment and fracture data were obtained from the IMS® Disease Analyzer patient database in Germany. Women with osteoporosis prescribed one of six specified oral bisphosphonates between December 2004 and November 2007 with no similar prescription for at least 1 year beforehand were eligible for analysis. Those treated with intravenous bisphosphonates were excluded. Persistence (prescription refill gap of ≤30 days or change of treatment frequency) and compliance (medication possession ratio) were measured for 2 years from therapy start.


Data from 4,147 women were evaluable, with a median oral bisphosphonate treatment duration of 145.5 days. Persistence rates after 1 and 2 years were 27.9% and 12.9%, respectively, and 66.3% of women were compliant. As expected, persistence rates were higher when the refill gap was increased to 60 or 90 days. No significant differences in 1-year persistence between patients on weekly or monthly treatment regimens were observed (28.6% and 29.4%, respectively), although 1-year persistence with daily treatment was only 7.2%. After 24 months of therapy, compliant women had fewer fractures than non-compliant women (88.1% and 85.0% fracture-free, respectively; p = 0.0147). In multivariate Cox regression analysis, treatment compliance was the only factor that significantly decreased fracture risk (p = 0.0034).


Compliance and persistence with oral bisphosphonates in German women with osteoporosis were inadequate. Better compliance and persistence can prevent fractures in these women.


Compliance Fracture rate Oral bisphosphonates Osteoporosis Persistence 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • P. Hadji
    • 1
  • V. Claus
    • 2
  • V. Ziller
    • 1
  • M. Intorcia
    • 3
  • K. Kostev
    • 4
  • T. Steinle
    • 5
  1. 1.Klinik für Gynäkologie, Gynäkologische Endokrinologie und OnkologiePhilipps-UniversityMarburgGermany
  2. 2.Health Economics & Outcomes ResearchIMS Health GmbH & Co. OHGMunichGermany
  3. 3.iHE, Amgen (Europe) GmbHZugSwitzerland
  4. 4.Centre of Excellence Patient DataIMS Health GmbH & Co. OHGMunichGermany
  5. 5.Health Economics, Amgen GmbHMunichGermany

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