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Risk of refracture associated with compliance and persistence with bisphosphonate therapy in Taiwan

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Abstract

Summary

Bisphosphonates have been used for the treatment of postmenopausal osteoporosis since the early 1990s and studies show that compliant patients experience a lower fracture rate. This cohort study showed that the compliance of Taiwanese patients was poor and the refracture risk was related to compliance with bisphosphonate therapy.

Introduction

Bisphosphonates are potent inhibitors of osteoclast activity, and reduce bone turnover by inhibiting bone resorption. According to Taiwanese reimbursement guidelines, patients with osteoporosis-related fractures are eligible for bisphosphonate treatment. This study aimed to elucidate the relationship of refracture risk with compliance/persistence with bisphosphonate therapy in Taiwan.

Methods

This was a retrospective, administrative, database analysis measuring the adherence status and impact of poor adherence to bisphosphonate therapy in Taiwan. Study data derived from the National Health Insurance Research Database (NHIRD) were used to assemble a cohort of all osteoporosis patients who initiated bisphosphonate treatment between January 1, 2004, and December 31, 2005. Patients were followed until death, end of registration in NHIRD, or end of study period (December 31, 2006), whichever occurred first. Compliance was calculated as medication possession ratio (MPR; sum of days of supply of osteoporosis medications divided by follow-up duration).

Results

The refracture rates for osteoporosis patients were 5.15 %, 7.36 %, and 8.49 % in the first, second, and third year, respectively, and were significantly lower for patients with >80 % compliance than with <80 % compliance (p < 0.05). Nearly 50 % patients were noncompliant (MPR < 80 %) at 3 months, and only around 30 % patients were adherent at 1 year. Refracture risk increased with MPR < 80 %, age, and co-morbidities like diabetes mellitus or dementia. Patients with concomitant statin medication had significantly lower refracture risk.

Conclusions

The compliance of Taiwanese patients with osteoporosis medication is poor, and refracture risk is related to compliance with bisphosphonate therapy.

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References

  1. Chie WC, Yang RS, Liu JP, Tsai KS (2004) High incidence rate of hip fracture in Taiwan: estimated from a Nationwide Health Insurance database. Osteoporos Int 15:998–1002

    Article  PubMed  CAS  Google Scholar 

  2. Delmas PD (2002) Treatment of postmenopausal osteoporosis. Lancet 359:2018–2026

    Article  PubMed  CAS  Google Scholar 

  3. Tsai KS, Tai TY (1997) Epidemiology of osteoporosis in Taiwan. Osteoporos Int 7(Suppl 3):S96–S98

    Article  PubMed  Google Scholar 

  4. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521

    Article  PubMed  CAS  Google Scholar 

  5. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis Prevention, Diagnosis, and Therapy. JAMA 285:785–795

    Article  Google Scholar 

  6. Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17S, discussion 17S–19S

    Article  PubMed  CAS  Google Scholar 

  7. Sweet MG, Sweet JM, Jeremiah MP, Galazka SS (2009) Diagnosis and treatment of osteoporosis. Am Fam Physician 79:193–200

    PubMed  Google Scholar 

  8. Association T.T.O. (2007) Osteoporosis treatment guideline. http://www.toa1997.org.tw. Accessed May 12 2009

  9. Yang NP, Deng CY, Chou YJ, Chen PQ, Lin CH, Chou P, Chang HJ (2006) Estimated prevalence of osteoporosis from a Nationwide Health Insurance database in Taiwan. Health Policy 75:329–337

    Article  PubMed  Google Scholar 

  10. Chow SN, Huang CC, Lee YT (1997) Demographic characteristics and medical aspects of menopausal women in Taiwan. J Formos Med Assoc 96:806–811

    PubMed  CAS  Google Scholar 

  11. Graham R, Russell G (2011) Bisphosphonates: The first 40 years. Bone 49:2–19

    Article  Google Scholar 

  12. Gallagher AM, Rietbrock S, Olson M, van Staa TP (2008) Fracture outcomes related to persistence and compliance with oral bisphosphonates. J Bone Miner Res 23:1569–1575

    Article  PubMed  Google Scholar 

  13. Solomon DH, Avorn J, Katz JN, Finkelstein JS, Arnold M, Polinski JM, Brookhart MA (2005) Compliance with osteoporosis medications. Arch Intern Med 165:2414–2419

    Article  PubMed  Google Scholar 

  14. Siris ES, Harris ST, Rosen CJ, Barr CE, Arvesen JN, Abbott TA, Silverman S (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 81:1013–1022

    Article  PubMed  Google Scholar 

  15. 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 80:856–861

    Article  PubMed  Google Scholar 

  16. Caro JJ, Ishak KJ, Huybrechts KF, Raggio G, Naujoks C (2004) The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 15:1003–1008

    Article  PubMed  Google Scholar 

  17. Weycker D, Macarios D, Edelsberg J, Oster G (2006) Compliance with drug therapy for postmenopausal osteoporosis. Osteoporos Int 17:1645–1652

    Article  PubMed  CAS  Google Scholar 

  18. Gold DT, Martin BC, Frytak JR, Amonkar MM, Cosman F (2007) A claims database analysis of persistence with alendronate therapy and fracture risk in post-menopausal women with osteoporosis. Curr Med Res Opin 23:585–594

    Article  PubMed  CAS  Google Scholar 

  19. Penning-van Beest FJ, Erkens JA, Olson M, Herings RM (2008) Loss of treatment benefit due to low compliance with bisphosphonate therapy. Osteoporos Int 19:511–517

    Article  PubMed  CAS  Google Scholar 

  20. Shao CJ, Hsieh YH, Tsai CH, Lai KA (2009) A nationwide seven-year trend of hip fractures in the elderly population of Taiwan. Bone 44:125–129

    Article  PubMed  Google Scholar 

  21. Chevalley T, Guilley E, Herrmann FR, Hoffmeyer P, Rapin CH, Rizzoli R (2007) Incidence of hip fracture over a 10-year period (1991–2000): reversal of a secular trend. Bone 40:1284–1289

    Article  PubMed  CAS  Google Scholar 

  22. Finsen V, Johnsen LG, Trano G, Hansen B, Sneve KS (2004) Hip fracture incidence in central Norway: a followup study. Clin Orthop Relat Res 173–178

  23. Hagino H, Katagiri H, Okano T, Yamamoto K, Teshima R (2005) Increasing incidence of hip fracture in Tottori Prefecture, Japan: trend from 1986 to 2001. Osteoporos Int 16:1963–1968

    Article  PubMed  Google Scholar 

  24. Wang Y, Tao Y, Hyman ME, Li J, Chen Y (2009) Osteoporosis in China. Osteoporos Int 20:1651–1662

    Article  PubMed  CAS  Google Scholar 

  25. Lau EM, Cooper C, Fung H, Lam D, Tsang KK (1999) Hip fracture in Hong Kong over the last decade–a comparison with the UK. J Public Health Med 21:249–250

    Article  PubMed  CAS  Google Scholar 

  26. Sikka R, Xia F, Aubert RE (2005) Estimating medication persistency using administrative claims data. Am J Manag Care 11:449–457

    PubMed  Google Scholar 

  27. Sheehy O, Kindundu C, Barbeau M, LeLorier J (2009) Adherence to weekly oral bisphosphonate therapy: cost of wasted drugs and fractures. Osteoporos Int 20:1583–1594

    Article  PubMed  CAS  Google Scholar 

  28. Adachi J, Lynch N, Middelhoven H, Hunjan M, Cowell W (2007) The association between compliance and persistence with bisphosphonate therapy and fracture risk: a review. BMC Musculoskelet Disord 8:97

    Article  PubMed  Google Scholar 

  29. Chen HF, Ho CA, Li CY (2008) Increased risks of hip fracture in diabetic patients of Taiwan: a population-based study. Diabetes Care 31:75–80

    Article  PubMed  CAS  Google Scholar 

  30. Cramer JA, Amonkar MM, Hebborn A, Altman R (2005) Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 21:1453–1460

    Article  PubMed  CAS  Google Scholar 

  31. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA (2002) Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA 287:337–344

    Article  PubMed  Google Scholar 

  32. Carr AJ, Thompson PW, Cooper C (2006) Factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis: a cross-sectional survey. Osteoporos Int 17:1638–1644

    Article  PubMed  CAS  Google Scholar 

  33. Rossini M, Bianchi G, Di Munno O, Giannini S, Minisola S, Sinigaglia L, Adami S (2006) Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 17:914–921

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This project was funded by Novartis Co., Inc., as a Phase IIIB clinical trial in Taiwan. We would like to thank Professor Chao-Hsiun Tang and the clinical staff at all study sites for their important contributions to the study. This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Linkou, No. 5, Fusing St., Gueishan Township, Taoyuan County, 333, Taiwan, Republic of China

    Y.-K. Soong & H.-Y. Huang

  2. Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Chung Shan S. Rd., Taipei, 100, Taiwan, Republic of China

    K.-S. Tsai

  3. Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Chung Shan S. Rd., Taipei, 100, Taiwan, Republic of China

    R.-S. Yang

  4. Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Kaohsiung, No. 123, Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien, 833, Taiwan, Republic of China

    J.-F. Chen

  5. Department of Family Medicine, Obesity and Body Composition Research Center, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan, 204, Taiwan, Republic of China

    P. C.-H. Wu

  6. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Kaohsiung and Chang Gung University, No. 123, Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien, 833, Taiwan, Republic of China

    K.-E. Huang

Authors
  1. Y.-K. Soong
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  2. K.-S. Tsai
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  3. H.-Y. Huang
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  4. R.-S. Yang
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  5. J.-F. Chen
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  6. P. C.-H. Wu
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  7. K.-E. Huang
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Corresponding author

Correspondence to Y.-K. Soong.

Appendices

Appendix 1

Table 4 Compliance (continuous MPR), persistence, and risk of refracture
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Appendix 2

Table 5 Compliance with statins and refracture risk
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Soong, YK., Tsai, KS., Huang, HY. et al. Risk of refracture associated with compliance and persistence with bisphosphonate therapy in Taiwan. Osteoporos Int 24, 511–521 (2013). https://doi.org/10.1007/s00198-012-1984-z

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  • DOI: https://doi.org/10.1007/s00198-012-1984-z

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