Osteoporosis International

, Volume 19, Issue 10, pp 1421–1429 | Cite as

Impact of compliance and persistence with bisphosphonate therapy on health care costs and utilization

  • J. A. SunyeczEmail author
  • L. Mucha
  • O. Baser
  • C. E. Barr
  • M. M. Amonkar
Original Article



The impact of persistence and compliance with bisphosphonate therapy on health care costs and utilization was examined in women newly prescribed bisphosphonates. At 3 years, women who were persistent and compliant with bisphosphonate therapy had lower total costs compared with non-persistent and non-compliant women, after controlling for relevant risk factors.


The impact of persistence and compliance with bisphosphonate therapy on health care costs and utilization was examined in bisphosphonate-naïve women.


Two claims databases were used to identify women ≥45 years of age and who filled a new bisphosphonate prescription during 2000–2002. Persistence and compliance were evaluated over 3 years. Compliance was defined as a medication possession ratio (days of bisphosphonate supply/days of follow-up) ≥0.80; persistence was defined as no refill gaps ≥30 days. Multivariate models accounted for potential confounders.


This analysis included 32,944 women (mean age, 64 years) who filled a new prescription for daily or weekly alendronate (n = 26,581) or risedronate (n = 6,363). At 3 years, 37% of women were compliant and 21% of women were persistent. Unadjusted total mean health care costs were lower for the compliant vs. non-compliant and persistent vs. non-persistent cohorts. After adjusting for potential confounders, total health care costs were reduced by 8.9% for persistent patients (p < 0.001) and 3.5% for compliant patients (p = 0.014). Persistence decreased the likelihood of inpatient admission by 47%.


At 3 years, women who were persistent and compliant with bisphosphonate therapy had lower total costs compared with non-persistent and non-compliant women, after controlling for relevant risk factors.


Bisphosphonates Compliance Cost Osteoporosis Persistence 



This study was supported Roche. J. Sunyecz has served on the speaker’s bureaus for Roche and GlaxoSmithKline and received research support from Roche and GlaxoSmithKline. L. Mucha is employed by Outcomes Research and Econometrics and has a contract with Roche for data analysis. O. Baser is a consultant for Thomson Healthcare has a contract with Roche for data analysis. C. E. Barr is employed by Roche. M. M. Amonkar is employed by GlaxoSmithKline. The authors acknowledge the assistance of Rebecca Jarvis, PhD in the preparation of this manuscript.

Conflicts of interest



  1. 1.
    Melton LJ 3rd (2003) Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res 18:1139–1141PubMedCrossRefGoogle Scholar
  2. 2.
    Barrett-Connor E (1995) The economic and human costs of osteoporotic fracture. Am J Med 98:3S–8SPubMedCrossRefGoogle Scholar
  3. 3.
    Office of the Surgeon General (2004) Bone Health and Osteoporosis: A Report of the Surgeon General. U.S. Department of Health and Human Services, Rockville, MDGoogle Scholar
  4. 4.
    Chrischilles E, Shireman T, Wallace R (1994) Costs and health effects of osteoporotic fractures. Bone 15:377–386PubMedCrossRefGoogle Scholar
  5. 5.
    Reginster JY (2006) Adherence and persistence: impact on outcomes and health care resources. Bone 38:S18–S21PubMedCrossRefGoogle Scholar
  6. 6.
    McClung MR (2003) Bisphosphonates. Endocrinol Metab Clin North Am 32:253–271PubMedCrossRefGoogle Scholar
  7. 7.
    Papapoulos SE (2000) Bisphosphonates in the treatment of osteoporosis. Principles and efficacy. Ann Med Interne (Paris) 151:504–510Google Scholar
  8. 8.
    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
  9. 9.
    Chesnut CH, Ettinger MP, Miller PD et al (2005) Ibandronate produces significant, similar antifracture efficacy in North American and European women: new clinical findings from BONE. Curr Med Res Opin 21:391–401PubMedCrossRefGoogle Scholar
  10. 10.
    Reginster J, Minne HW, Sorensen OH et al (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11:83–91PubMedCrossRefGoogle Scholar
  11. 11.
    Harris ST, Watts NB, Genant HK et al (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282:1344–1352PubMedCrossRefGoogle Scholar
  12. 12.
    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
  13. 13.
    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
  14. 14.
    Recker RR, Gallagher R, MacCosbe PE (2005) Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 80:856–861PubMedGoogle Scholar
  15. 15.
    Lombas C, Hakim C, Zanchetta JR (2001) Compliance with alendronate treatment in an osteoporosis clinic. J Bone Miner Res 16(Suppl 1):S529Google Scholar
  16. 16.
    McClung MR (2000) Bisphosphonates in osteoporosis: recent clinical experience. Expert Opin Pharmacother 1:225–238PubMedCrossRefGoogle Scholar
  17. 17.
    Yood RA, Emani S, Reed JI et al (2003) Compliance with pharmacologic therapy for osteoporosis. Osteoporos Int 14:965–968PubMedCrossRefGoogle Scholar
  18. 18.
    Gold DT, Martin BC, Frytak JR et al (2007) A claims database analysis of persistence with alendronate therapy and fracture risk in post-menopausal women with osteoporosis. Curr Med Res Opin 23:585–594PubMedCrossRefGoogle Scholar
  19. 19.
    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
  20. 20.
    Al-Maatouq MA, El-Desouki MI, Othman SA et al (2004) Prevalence of osteoporosis among postmenopausal females with diabetes mellitus. Saudi Med J 25:1423–1427PubMedGoogle Scholar
  21. 21.
    Vestergaard P, Mosekilde L (2002) Fractures in patients with hyperthyroidism and hypothyroidism: a nationwide follow-up study in 16,249 patients. Thyroid 12:411–419PubMedCrossRefGoogle Scholar
  22. 22.
    Meier CR, Schlienger RG, Kraenzlin ME et al (2000) HMG-CoA reductase inhibitors and the risk of fractures. JAMA 283:3205–3210PubMedCrossRefGoogle Scholar
  23. 23.
    Steinbuch M, Youket TE, Cohen S (2004) Oral glucocorticoid use is associated with an increased risk of fracture. Osteoporos Int 15:323–328PubMedCrossRefGoogle Scholar
  24. 24.
    Sikka R, Xia F, Aubert RE (2005) Estimating medication persistency using administrative claims data. Am J Manag Care 11:449–457PubMedGoogle Scholar
  25. 25.
    Billups SJ, Malone DC, Carter BL (2000) The relationship between drug therapy noncompliance and patient characteristics, health-related quality of life, and health care costs. Pharmacotherapy 20:941–949PubMedCrossRefGoogle Scholar
  26. 26.
    McCombs JS, Thiebaud P, McLaughlin-Miley C et al (2004) Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 48:271–287PubMedCrossRefGoogle Scholar
  27. 27.
    Cramer JA, Amonkar MM, Hebborn A et al (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 21:1453–1460PubMedCrossRefGoogle Scholar
  28. 28.
    Manning WG, Mullahy J (2001) Estimating log models: to transform or not to transform? J Health Econ 20:461–494PubMedCrossRefGoogle Scholar
  29. 29.
    Gold DT, McClung B (2006) Approaches to patient education: emphasizing the long-term value of compliance and persistence. Am J Med 119:S32–S37PubMedCrossRefGoogle Scholar
  30. 30.
    Gold DT, Silverman S (2006) Review of adherence to medications for the treatment of osteoporosis. Curr Osteoporos Rep 4:21–27PubMedCrossRefGoogle Scholar
  31. 31.
    Emkey RD, Ettinger M (2006) Improving compliance and persistence with bisphosphonate therapy for osteoporosis. Am J Med 119:S18–S24PubMedCrossRefGoogle Scholar
  32. 32.
    Gibson TB, Mark TL, Axelsen K, et al. (2006) Impact of statin copayments on adherence and medical care utilization and expenditures. Am J Manag Care 12 Spec no.:SP11–19Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2008

Authors and Affiliations

  • J. A. Sunyecz
    • 1
    Email author
  • L. Mucha
    • 2
  • O. Baser
    • 3
    • 6
  • C. E. Barr
    • 4
  • M. M. Amonkar
    • 5
  1. 1.Laurel Highlands Ob/Gyn, PCHopwoodUSA
  2. 2.Outcomes Research and EconometricsCambridgeUSA
  3. 3.Thomson HealthcareAnn ArborUSA
  4. 4.RocheNutleyUSA
  5. 5.GlaxoSmithKlineCollegevilleUSA
  6. 6.University of Michigan Medical SchoolAnn ArborUSA

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