Compliance with drug therapy for postmenopausal osteoporosis
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Patient compliance with pharmacotherapy for osteoporosis is typically poor in clinical practice; less frequent dosing with bisphosphonates may improve compliance.
Using data from 49 US health plans, we identified all women aged ≥45 years with osteoporosis who initiated therapy with a bisphosphonate, calcitonin, estrogen, or raloxifene. Compliance was examined alternatively in terms of incidence of adherence failure (medication days <80% of possible) and persistence failure (gap in therapy ≥90 days), and was compared across treatment groups using Kaplan-Meier methods and Cox proportional hazards models.
The study population included 18,822 women, 48% of whom initiated weekly bisphosphonate therapy. Overall risk of adherence failure was 47% at 3 months, 70% at 1 year, and 84% at 3 years. Risk of persistence failure was 47% at 1 year, and 77% at 3 years. In multivariate analyses, risk of adherence failure was higher for calcitonin (hazard ratio=2.7 vs weekly bisphosphonate therapy, p<0.01), but comparable for all other therapies. Relative risks of persistence failure were generally similar.
Approximately three-quarters of women who initiate osteoporosis drug therapy are non-adherent with treatment within 12 months, and almost 50% have discontinued such therapy by this time. Compliance with weekly bisphosphonate therapy is generally no better than that with osteoporosis medications requiring more frequent dosing.
KeywordsAdherence Compliance Osteoporosis Pharmacotherapy
Funding for this research was provided by Amgen, Inc., Thousand Oaks, California. The authors thank Manjusha Gokhale, M.P.H. of Policy Analysis Inc. (PAI) for assistance with data management and data processing and Enkhe Badamgarav, M.D., M.P.H., of Amgen Inc. for valuable comments on the manuscript.
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