Abstract
Background and aims: In clinical trials, the most frequent reasons for treatment discontinuation are adverse events and personal conflicts with medical staff. However, in ‘real life’, i.e. not in the frame of a controlled and monitored trial, other reasons are also possible, when not only discontinuation, but also switching of treatment happens. The aim of this study was to estimate how often and why persistent osteoporosis patients switch from one treatment to another. Methods: A retrospective analysis of 1314 ambulatory treated persistent osteoporosis patients was performed (1180 F, 134 M, mean age±SD: 66.5±10 yrs, BMI 26.4±4.2 kg/m2). Drugs used for osteoporosis, duration of treatment, frequency and reasons for drug switching were all analyzed. Results: In 530 (40.3%) patients, treatment was not changed during the observation period (16.1±9.1 months). In 784 (59.7%) patients at least one drug switch happened, and the total number of switches was 1117 (1–5 switches/patient). The mean time of observation in this group was 22.3±14.9 months. The most frequent reasons for drug switching were: adverse event (34.6% of all switches), high price of the drug (28.7%) and ineffective treatment (13.3%). Conclusions: In almost 60% of the persistent patients, at least one switch of antiosteoporotic treatment occurred in the nearly 2-year observation period. The most frequent reasons for drug switching were adverse reactions, the high price of the drug, and ineffective treatment.
Similar content being viewed by others
References
Kanis JA. Osteoporosis III: Diagnosis of osteoporosis and assessment of fracture risk. Lancet 2002; 359: 1929–36.
Zuckerman JD. Hip fracture. N Engl J Med 1996; 334: 1519–25.
Ray NF, Chan JK, Thamer M, Melton DI JL. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12: 24–35.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007; 22: 465–75.
Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D. Risk of mortality following clinical fracture. Osteoporos Int 2000; 7: 556–61.
Bone HG, Hosking D, Devogelaer J-P et al. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004; 350: 1189–99.
Mellstroem DD, Sorensen OH, Goemaere S, Roux C, Johnson TD, Chines AA. Seven years of treatment with risedronate in women with postmenopusal osteoporosis. Calcif Tissue Int 2004; 75: 462–8.
Black DM, Schwartz AV, Ensrud KE et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX) randomized trial. JAMA 2006; 296: 2927–38.
Papaioannou A, Kennedy CC, Dolovich L, Lau E, Adachi JD. Patient adherence to osteoporosis medications: problems, consequences and managing strategies. Drugs Aging 2007; 24: 37–55.
Caro JJ, Ishak KJ, Huybrechts KF, Raggio G, Naujoks C. The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 2004; 15: 1003–8.
Briesacher BA, Andrade SE, Yood RA, Kahler KH. Consequences of poor compliance with bisphosphonates. Bone 2007; 41: 882–7.
Recker RR, Gallagher R, MacCosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005; 80: 856–61.
Weycker D, Macarios D, Edelsberg J, Oster G. Compliance with drug therapy for postmenopausal osteoporosis. Osteoporos Int 2006; 17: 1645–52.
Reginster J-Y, Minne HW, Sorenses OH et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Osteoporos Int 2000; 11: 83–91.
Bauer DC, Black D, Ensrud K et al. Upper gastrointestinal tract safety profile of alendronate. Arch Intern Med 2000; 160: 517–25.
Bonnick SI, Shulman L. Monitoring osteoporosis therapy: bone mineral density, bone turnover markers, or both? Am J Med 2006;119(4 Suppl 1): S25–31.
Neer RM, Arnaud CD, Zanchetta JR et al. Effect of parathyroid hormone (12–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344: 1434–41.
Black DM, Thompson DE, Bauer DC et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metabol 2000; 85: 4118–24.
Harris ST, Watts NB, Genant HK et al. Effects of risedronate treatment on vertebral and non-vertebral fractures in women with postmenopausal osteoporosis. JAMA 1999; 282: 1344–52.
Ettinger B, Black DM, Mitlak BH et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene. JAMA 1999; 282: 637–45.
Meunier PJ, Roux C, Seeman E et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 2004; 350; 459–68.
Reginster JY, Seeman E, De Vernejoul MC et al. Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: TROPOS Study. J Clin Endocrinol Metab 2005; 90: 2816–22.
McClung MR, Geusens P, Miller PD et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001; 344: 333–40.
Wichrowska H, Kyziol-Otto G, Kostrzewski P, Franek E. Czestosc i przyczyny zmian leków stosowanych w leczeniu osteoporozy (Frequency and reasons for drug changes during osteoporosis treatment). Two] Mag Med 2005; 10: 56–60.
Simon JA, Lewiecki EM, Smith ME, Petruschke RA, Wang L, Palmisano JJ. Patient preference for once-weekly alendronate 70 mg versus once-daily alendronate 10 mg: a multicenter, randomized, open-labeled, crossover study. Clin Ther 2002; 24: 1871–86.
Carr AJ, Thompson PW, Cooper C. Factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis: a cross-sectional study. Osteoporos Int 2006; 17: 1638–44.
Wilson IB, Schoen C, Neuman P et al. Physician-patient communication about prescription medication nonadherence: A 50-State study of America’s seniors. J Gen Intern Med 2007; 22: 6–12.
Weiss TW, McHorney CA. Osteoporosis medication profile preference: results from the PREFER-US study. Health Expect 2007; 10: 211–23.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Franek, E., Tałałaj, M., Wichrowska, H. et al. Common drug switching during long-term antiresorptive treatment: experience of four osteoporosis centers in Poland (2001–2005). Aging Clin Exp Res 20, 528–532 (2008). https://doi.org/10.1007/BF03324880
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03324880