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Primary non-adherence to bisphosphonates in an integrated healthcare setting



We estimated primary non-adherence to oral bisphosphonate medication and examined the factors associated with primary non-adherence. Nearly 30 % of women did not pick up their new bisphosphonate within 60 days. Identifying barriers and developing interventions that address patients’ needs and concerns at the time a new medication is prescribed are warranted.


To estimate primary non-adherence to oral bisphosphonate medications using electronic medical record data in a large, integrated healthcare delivery system and to describe patient and prescribing provider factors associated with primary non-adherence.


Women aged 55 years and older enrolled in Kaiser Permanente Southern California (KPSC) with a new prescription for oral bisphosphonates between December 1, 2009 and March 31, 2011 were identified. Primary non-adherence was defined as failure to pick up the new prescription within 60 days of the order date. Multivariable logistic regression models were used to investigate patient factors (demographics, healthcare utilization, and health conditions) and prescribing provider characteristics (demographics, years in practice, and specialty) associated with primary non-adherence.


We identified 8,454 eligible women with a new bisphosphonate order. Among these women, 2,497 (29.5 %) did not pick up their bisphosphonate prescription within 60 days of the order date. In multivariable analyses, older age and emergency department utilization were associated with increased odds of primary non-adherence while prescription medication use and hospitalizations were associated with lower odds of primary non-adherence. Prescribing providers practicing 10 or more years had lower odds of primary non-adherent patients compared with providers practicing less than 10 years. Internal medicine and rheumatology providers had lower odds of primary non-adherent patients than primary care providers.


This study found that nearly one in three women failed to pick up their new bisphosphonate prescription within 60 days. Identifying barriers and developing interventions aimed at reducing the number of primary non-adherent patients to bisphosphonate prescriptions are warranted.

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This study was funded by a contractual agreement between Kaiser Permanente Southern California and Amgen Inc., Thousand Oaks, CA.

Conflicts of interest

Dr. O’Malley is an employee of Amgen Inc. and owns stock in Amgen Inc. Drs. Muntner, Gold, Silverman, and Morisky have served as advisors for Amgen Inc. Drs. Muntner, Gold and Silverman have served as consultants for Amgen Inc. Drs. Reynolds and Muntner received research support from Amgen Inc. Dr. Silverman has served as an advisor for Lilly, Novartis and Pfizer/Wyeth. Dr. Silverman has served as a consultant for Genentech, Lilly, Novartis and Pfizer/Wyeth. Dr. Silverman has received research support from Lilly and Pfizer/Wyeth. This study was funded by a contractual agreement between Kaiser Permanente Southern California and Amgen Inc., Thousand Oaks, CA.

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Correspondence to K. Reynolds.

Appendix 1

Appendix 1

Table 4 International classification of diseases, 9th revision, Clinical modification (ICD-9-CM) codes

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Reynolds, K., Muntner, P., Cheetham, T.C. et al. Primary non-adherence to bisphosphonates in an integrated healthcare setting. Osteoporos Int 24, 2509–2517 (2013).

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  • Adherence
  • Bisphosphonates
  • Postmenopausal osteoporosis
  • Primary non-adherence