Osteoporosis International

, Volume 24, Issue 4, pp 1483–1489 | Cite as

Adherence with bisphosphonate therapy and change in bone mineral density among women with osteoporosis or osteopenia in clinical practice

  • D. Weycker
  • L. Lamerato
  • S. Schooley
  • D. Macarios
  • T. Siu Woodworth
  • N. Yurgin
  • G. Oster
Original Article



In clinical practice, adherence with bisphosphonate therapy varies greatly among women with osteoporosis or osteopenia. Our study suggests that better adherence with bisphosphonates confers tangible benefits in terms of graded increases in bone mineral density. Interventions to improve drug adherence should be an important component of disease management.


In clinical trials, bisphosphonates have been found to increase bone mineral density (BMD) in women with osteoporosis or osteopenia. In clinical practice, where drug adherence is more variable, change in BMD with bisphosphonate therapy—overall and by level of adherence—is largely unknown.


A retrospective cohort study was conducted at Henry Ford Health System (Detroit, MI, USA). Study subjects were women who had low BMD at the left total hip (T-score < −1.0), began oral bisphosphonate therapy, and had ≥1 BMD measurements at the left total hip ≥6 months following treatment initiation. Change in BMD was calculated between the most recent pretreatment scan and the first follow-up scan. Adherence (i.e., medication possession ratio (MPR)) was measured from therapy initiation to the first follow-up scan.


Among 644 subjects, mean age was 66 years, pretreatment BMD was 0.73 g/cm2, and pretreatment T-score was −1.8. Over a mean follow-up of 27.1 months, mean MPR was 0.57 (95 % CI, 0.54 and 0.59), and mean percentage change in BMD was 1.5 % (1.1 and 1.9 %). Within the MPR strata (five consecutive equi-intervals, from low (0–0.19) to high (0.80–1.0)), mean change in BMD was −0.8 % (−1.6 and 0.1 %), 0.7 % (−0.3 and 1.7 %), 2.1 % (1.1 and 3.0 %), 2.1 % (1.4 and 2.9 %), and 2.9 % (2.3 and 3.5 %), respectively. In adjusted analyses, percentage change in BMD was higher (by 1.4–3.4 %, p < 0.05 for all) in the highest four MPR intervals, respectively, versus MPR 0–0.19.


Among women with osteoporosis or osteopenia in clinical practice, better adherence with bisphosphonates appears to confer tangible benefits in terms of increases in BMD.


Bisphosphonates Bone mineral density Medication adherence Osteoporosis Osteopenia Treatment effectiveness 


Conflicts of interest

Funding for this research was provided by Amgen Inc. to Policy Analysis Inc. (PAI). Gerry Oster and Derek Weycker are employed by PAI; Tiffany Siu Woodworth was employed by PAI during the conduct of this study. Dave Macarios and Nicole Yurgin are employed by Amgen Inc. Lois Lamerato and Susan Schooley are employed by Henry Ford Health System (HFHS), which received research funding from PAI. Amgen Inc. reviewed and approved the study research plan and study manuscript; data management, processing, and analyses were conducted by PAI and HFHS, and all final analytic decisions were made by the study authors.


  1. 1.
    Lyles KW, Colon-Emeric CS, Magaziner JS et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809PubMedCrossRefGoogle Scholar
  2. 2.
    McCarus DC (2006) Fracture prevention in postmenopausal osteoporosis: a review of treatment options. Obstet Gynecol Surv 61:39–50PubMedCrossRefGoogle Scholar
  3. 3.
    Boonen S, Laan RF, Barton IP, Watts NB (2005) Effect of osteoporosis treatments on risk of non-vertebral fractures: review and meta-analysis of intention-to-treat studies. Osteoporos Int 16:1291–1298PubMedCrossRefGoogle Scholar
  4. 4.
    Cranney A, Guyatt G, Griffith L et al (2002) Meta-analyses of therapies for postmenopausal osteoporosis. IX: summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 23:570–578PubMedCrossRefGoogle Scholar
  5. 5.
    Cummings SR, Black DM, Thompson DE et al (1998) Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 280:2077–2082PubMedCrossRefGoogle Scholar
  6. 6.
    Black DM, Cummings SR, Karpf DB et al (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541PubMedCrossRefGoogle Scholar
  7. 7.
    Huybrechts KF, Ishak KJ, Caro JJ (2006) Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 38:922–928PubMedCrossRefGoogle Scholar
  8. 8.
    Siris ES, Harris ST, Rosen CJ et al (2006) Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 81:1013–1022PubMedCrossRefGoogle Scholar
  9. 9.
    Weycker D, Macarios D, Edelsberg J, Oster G (2006) Compliance with drug therapy for postmenopausal osteoporosis. Osteoporos Int 17:1645–1652PubMedCrossRefGoogle Scholar
  10. 10.
    Caro JJ, Ishak KJ, Huybrechts KF et al (2004) The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 15:1003–1008PubMedCrossRefGoogle Scholar
  11. 11.
    McCombs JS, Thiebaud P, Laughlin-Miley C, Shi J (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48:271–287PubMedCrossRefGoogle Scholar
  12. 12.
    Ettinger B, Pressman AR, Schein J et al (1998) Alendronate use among 812 women: prevalence of gastrointestinal complaints, non-compliance with patient instructions, and discontinuation. JMCP 4:488–492Google Scholar
  13. 13.
    Weycker D, Macarios D, Edelsberg J, Oster G (2007) Compliance with drug therapy and risk of fracture. Osteoporos Int 18:271–277PubMedCrossRefGoogle Scholar
  14. 14.
    Adami S, Isaia G, Luisetto G et al (2006) Fracture incidence and characterization in patients on osteoporosis treatment: the ICARO study. J Bone Miner Res 21:1565–1570PubMedCrossRefGoogle Scholar
  15. 15.
    Feldstein AC, Weycker D, Nichols G et al (2009) Effectiveness of bisphosphonate therapy in a community setting. Bone 44:153–159PubMedCrossRefGoogle Scholar
  16. 16.
    Yood RA, Emani S, Reed JI et al (2003) Adherence with pharmacologic therapy for osteoporosis. Osteoporos Int 14:965–968PubMedCrossRefGoogle Scholar
  17. 17.
    Bell NH, Bilezikian JP, Bone HG et al (2002) Alendronate increase bone mass and reduces bone markers in postmenopausal African-American women. J Clin Endocrinol Metab 87:2792–2797PubMedCrossRefGoogle Scholar
  18. 18.
    Chesnut CH, McClung MR, Ensrud KE et al (1995) Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. Am J Med 99:144–152Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  • D. Weycker
    • 1
  • L. Lamerato
    • 2
  • S. Schooley
    • 2
  • D. Macarios
    • 3
  • T. Siu Woodworth
    • 1
  • N. Yurgin
    • 3
  • G. Oster
    • 1
  1. 1.Policy Analysis Inc. (PAI)BrooklineUSA
  2. 2.Henry Ford Health SystemDetroitUSA
  3. 3.Amgen Inc.Thousand OaksUSA

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