Osteoporosis International

, Volume 17, Issue 5, pp 664–671 | Cite as

Does an educational leaflet improve self-reported adherence to therapy in osteoporosis? The OPTIMA study

  • M. GuileraEmail author
  • M. Fuentes
  • M. Grifols
  • J. Ferrer
  • X. Badia
  • OPTIMA study investigators
Original Article



Adherence to treatment in osteoporosis remains poor. The aim of this study was to evaluate the effects of an educational leaflet on adherence to medication and to assess the association between adherence and health-related quality of life (HRQOL).


A naturalistic, observational, multi-center, prospective study of 12 months’ follow-up was performed. Consecutive post-menopausal women aged 50 years to 86 years starting treatment with raloxifene according to daily practice were enrolled from 126 primary care offices in Spain. The women were assigned to two study groups. Group A received an educational leaflet with general information about osteoporosis; group B followed current practice. To assess adherence to medication and HRQOL, the Morisky test and the EuroQoL questionnaire were administered. A total of 745 post-menopausal women (group A, n=366; group B n=379), with a mean age of 62 years, were included.


Most patients in both study groups showed high adherence to raloxifene at the 3-month visit: 56.3% vs 62.7% for groups A and B, respectively; this proportion at the 12-month visit was 47.4% (P=0.15) and 52.5% (P=0.02), respectively. At baseline, “pain/discomfort” was the dimension showing the highest percentage of women reporting problems: 86.4% vs 83.2% in groups A and B, respectively (P=0.22). HRQOL improved in both groups throughout the study, with an overall mean increment in the EuroQoL visual analog scale (EQ VAS) of 9.2 at 12 months (P<0.01). Correlations between adherence and HRQOL were weak. After receiving an educational leaflet, young post-menopausal women suffering osteoporosis did not show improvement in adherence to therapy. HRQOL improved at 12-month follow-up under treatment.


No consistent correlation between adherence and HRQOL was found.


Adherence HRQOL Osteoporosis Raloxifene 



We wish to thank all general practitioners participating in the OPTIMA study: Dr. Benilde Tejido Garca, Dr. Dolores Prados Cano, Dr. Jose Felix Paredes Monelos, Dr. Jose Vazquez Cacheiro, Dr. Ma Jose Veleiro Tenreiro, Dr. Cristina Iglesias Diaz, Dr. Manuel Alonso Diaz, Dr. Jose Ma Garcia Polon, Dr. Martin San Millan Honrado, Dr. Carmen Amez Revuelta, Dr. Joaquin Juan Dieguez, Dr. Miguel Angel Rodriguez Lois, Dr. Montserrat Latorre Casedas, Dr. Maria Cerrato Rodriguez, Dr. Jose Manuel Goimil Martinez, Dr. Julio Rica Jelusich, Dr. Jose Miguel De Barruetabeña Gutierrez, Dr. Manuel Pena Otero, Dr. Alberto Losada Martínez, Dr. Francisco Pazos, Dr. Eduardo Tamayo Aguirre, Dr. Pablo Ferreiro Alonso, Dr. Jose Felix Zuazagoitia Nabla, Dr. Ma Angeles Sanza Garcia, Dr. Jose A. Estevez Barrondo, Dr. Jose Toledo Martinez, Dr. Carmen Garces Romero, Dr. Laura Martinez Alonso, Dr. Jose A. Montiu Peman, Dr. Estela Rodrigo, Dr. Ma Dolores Garcia Benaite, Dr. Jaime Cortes, Dr. Jose Manuel Ballester, Dr. Antonio Serrano Olover, Dr. Montserrat Espuga Garcia, Dr. Rosa Freixedas Casaponsa, Dr. Joan Isidro Ortega, Dr. Rosa Segarra Granell, Dr. Ma Luisa Moro Esteban, Dr. Ma Pilar Paramo Abai, Dr. Antonia Alonso Fresneda, Dr. Merce Fuentas Pujol, Dr. Casimir Moneny Sanchez, Dr. Eliseo Castell Friguls, Dr. Josep Ma Sans I Escola, Dr. Javier Rodriguez Pascual, Dr. Margarita Cañizares Nuñez, Dr. Josep Sorribes Lopez, Dr. Emili Balague Portus, Dr. Narcis Gratacos, Dr. Joan Cartanya, Dr. Juan Antonio Contreras Torres, Dr. Carlos Almendro Padill, Dr. Amparo Garcia Royo, Dr. Rosario Gonzalez Cabeza, Dr. Vicente Gasull Molinera, Dr. Ma Luisa Altarriba Cano, Dr. Francisco Beneyto Castello, Dr. Luis Estal Andres, Dr. Rosa Albelda Vendrell, Dr. Eduardo Canto Rodriguez, Dr. Jesus Navas Cutanda, Dr. Francisco Anton Garcia, Dr. Emilia Hernanz Torres, Dr. Ramon Lopez Guillen, Dr. Francisco Martinez Aguilar, Dr. Alejandra Caturla Perez, Dr. Fatima Perez Martinez, Dr. Daniel Vicente Fuentes, Dr. Francisco Martinez Cruz, Dr. Jose Segura Palomares, Dr. Jose Rodriguez Fernandez, Dr. Vicente Laborda Reinon, Dr. Jose Antonio Perez Lopez, Dr. Sebastian Jose Perez Martinez, Dr. Jose Manuel Suarez Sanchez, Dr. Ma Isabel Moreno Moreno, Dr. Carlos Martin Perez, Dr. Jose Andres Lopez Del Hierro, Dr. Nicolas Garrido Redondo, Dr. Cristobal Rodriguez Vicioso, Dr. Salvador Gotor Maroto, Dr. Salvador Cardenas Viedma, Dr. David Molina Fernandez, Dr. Ernesto Dios Lopez, Dr. Gabriel Caro Ruiz, Dr. Juan Manuel Lopez Zajara, Dr. Santiago Lupiani Gimenez, Dr. Jesus Casado Recio, Dr. Antonio Maine Martinez, Dr. Isabel Ramirez Polo, Dr. Rodrigo Romero Bernal, Dr. Juan Luis Hinojosa Gallardo, Dr. Francisco Manzano Gomez, Dr. Miguel Garcia Leon, Dr. Antonio Ortega Cabezaz, Dr. Miguel Silva Cueto, Dr. Fernando Morales Fernandez, Dr. Rafael Nieto Cervera, Dr. Luis Villanueva Horh, Dr. Ildefonso Esteban Fonseca, Dr. Juan Antonio Martin Jimenez, Dr. Carlos Miranda Fernandez-Santos, Dr. Luis Vitores Montoya, Dr. Emerito Peramato Martin, Dr. J. Sanchez Acosta, Dr. Juan Ignacio Pintado Pico, Dr. Maria De La O Bueno Reyes, Dr. Antonio Ruiz Garcia, Dr. Ezequiel Arranz Martinez, Dr. Emilio Jose Delgado Hellin, Dr. Dolores Sanchez Sanchez, Dr. Feliciano Lopez Sanhcez, Dr. Pablo Romero Marquez, Dr. Ana Martinez Cabrera, Dr. Esther Moreno Gonzalez, Dr. Purificacion Martinez Vilariño, Dr. Ma Fatima Garcia Areces, Dr. Domingo Ly Pen, Dr. Ma Luisa Gomez Rabago, Dr. Ma Jose Alvarez Pasquin, Dr. Francisco Cirujano Pita, Dr. Ma Antonia Martinez Montero, Dr. Maria Davalos De Haro, Dr. Ma Luisa Sanchez Ludeña, Dr. Ma Luz Caballero Hijon. The study was financially supported by PENSA-Esteve S.A and conducted by HOR-Europe.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • M. Guilera
    • 1
    Email author
  • M. Fuentes
    • 2
  • M. Grifols
    • 3
  • J. Ferrer
    • 4
  • X. Badia
    • 1
  • OPTIMA study investigators
  1. 1.Health Outcomes Research EuropeBarcelonaSpain
  2. 2.Centre Atenció PrimariaAlt BerguedàBarcelonaSpain
  3. 3.Medical Department EsteveBarcelonaSpain
  4. 4.Gynecolopy DepartmentHospital Central de AsturiasOviedoSpain

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