Osteoporosis International

, Volume 24, Issue 10, pp 2639–2647 | Cite as

Association between refill compliance to oral bisphosphonate treatment, incident fractures, and health care costs—an analysis using national health databases

  • K. R. Olsen
  • C. Hansen
  • B. AbrahamsenEmail author
Original Article



The study estimates the cost of poor and suboptimal refill compliance by estimating fracture costs and assessing the association between refill compliance with oral bisphosphonates and incident fractures using Danish health registers. Patients with poor and suboptimal refill compliance had more major osteoporotic fractures, and the direct costs related to hospital care, primary care, and pharmaceutical treatment for these excess fractures reached almost 14 M DKK (2.5 M USD) for the study population which compares to a national annual excess cost of around 17 M DKK (3.1 M USD) using 2011 prescription prevalence.


Adherence to oral anti-osteoporosis treatment has been shown in several studies to be relatively low and the potential impact on fracture burden is high. The aim of the study was to assess the association between refill compliance and all-cause health care costs.


A national dataset was extracted with all treatment-naive patients who began oral bisphosphonate (BP) treatment for osteoporosis in Denmark between 1997 and 2006 (N = 54,876, 87 % women). Patients who survived for at least 2 years (N = 47,176) were divided into groups based on Medication Possession Ratio (MPR). Logistic regressions were used to derive difference in the probability of incident fractures between the three MPR groups. Fracture costs (related to medication use, primary care practice, specialists, and hospitals) were derived by comparing cost 12 months before and after fracture.


For alendronate, the adjusted risk of major osteoporotic fractures was significantly reduced (OR 0.768; 0.686–0.859), including fractures of the hip (0.718; 0.609–0.846) and humerus (0.54; 0.431–0.677) with MPR ≥ 0.8. The risk reduction was lower with etidronate. Over 2 years, a total of 171 hip fractures and 53 other major osteoporotic fractures were attributed to suboptimal or poor refill compliance, with an excess cost of 13.7 M DKK (2.5 M USD).


Poor refill compliance is not unusual in patients on oral bisphosphonates, and we demonstrate that this is accompanied by excess major osteoporotic fractures and health care costs at the societal level.


Bisphophonates Epidemiology Fractures Health economics Osteoporosis 



This study was funded through a research grant from Amgen (Europe) GmbH. The funding source did not have any influence on the data analysis, interpretation, or conclusions but approved the final manuscript prior to submission. KRO is an employee of GSK Denmark and of the University of Southern Denmark and participated in this work as a GSK employee.

Conflicts of interest

CH has received speaker's fees from Eli Lilly. KRO is a GSK Denmark employee. BA has served as an investigator in clinical trials and on advisory boards and/or speakers panels for pharmaceutical companies that produce osteoporosis drugs. Clinical trials: Amgen, NPS Pharmaceuticals. Advisory boards: Amgen, Takeda-Nycomed, Merck. Speakers panels: Amgen, Nycomed, Eli Lilly, Merck.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  1. 1.GSK Pharma A/S, Nykær 68BroendbyDenmark
  2. 2.Research Unit of Nursing, Institute of Clinical Research, Faculty of Health SciencesUniversity of Southern DenmarkOdense MDenmark
  3. 3.Department of Medicine CGentofte University HospitalHellerupDenmark
  4. 4.Department of Medicine FGentofte University HospitalHellerupDenmark
  5. 5.Odense Patient Data Exploratory Network, Institute of Clinical Research, Faculty of Health SciencesUniversity of Southern DenmarkOdense MDenmark

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