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Osteoporosis International

, Volume 29, Issue 12, pp 2623–2637 | Cite as

A systematic review of factors affecting medication adherence among patients with osteoporosis

  • C. T. Yeam
  • S. Chia
  • H. C. C. Tan
  • Y. H. Kwan
  • W. Fong
  • J. J. B. SengEmail author
Review Article

Abstract

Summary

The aim of this review was to identify factors that influence patients’ adherence to anti-osteoporotic therapy. Factors identified that were associated with poorer medication adherence included polypharmacy, older age, and misconceptions about osteoporosis. Physicians need to be aware of these factors so as to optimize therapeutic outcomes for patients.

Introduction

To identify factors that influence patients’ adherence to anti-osteoporotic therapy.

Methods

A systematic review of literature was performed for articles published up till January 2018 using PubMed®, PsychINFO®, Embase®, and CINAHL®. Peer-reviewed articles which examined factors associated with anti-osteoporotic medication adherence were included. Classes of anti-osteoporotic therapy included bisphosphonates, parathyroid hormone-related analogue, denosumab, selective estrogen receptor modulators, estrogen/progestin therapy, calcitonin, and strontium ranelate. Meta-analyses, case reports/series, and other systematic reviews were excluded. Identified factors were classified using the World Health Organization’s five dimensions of medication adherence (condition, patient, therapy, health-system, and socio-economic domains).

Results

Of 2404 articles reviewed, 124 relevant articles were identified. The prevalence of medication adherence ranged from 12.9 to 95.4%. Twenty-four factors with 139 sub-factors were identified. Bisphosphonates were the most well-studied class of medication (n = 59, 48%). Condition-related factors that were associated with poorer medication adherence included polypharmacy, and history of falls was associated with higher medication adherence. Patient-related factors which were associated with poorer medication adherence included older age and misconceptions about osteoporosis while therapy-related factors included higher dosing frequency and medication side effects. Health system-based factors associated with poorer medication adherence included care under different medical specialties and lack of patient education. Socio-economic-related factors associated with poorer medication adherence included current smoker and lack of medical insurance coverage.

Conclusion

This review identified factors associated with poor medication adherence among osteoporotic patients. To optimize therapeutic outcomes for patients, clinicians need to be aware of the complexity of factors affecting medication adherence.

Keywords

Anti-osteoporotic therapy Medication adherence Osteoporosis Patient compliance Bisphosphonates 

Notes

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest

None.

Supplementary material

198_2018_4759_MOESM1_ESM.docx (65 kb)
ESM 1 (DOCX 64 kb)

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • C. T. Yeam
    • 1
  • S. Chia
    • 1
  • H. C. C. Tan
    • 1
  • Y. H. Kwan
    • 1
    • 2
  • W. Fong
    • 1
    • 3
    • 4
  • J. J. B. Seng
    • 1
    Email author
  1. 1.Duke-NUS Medical SchoolSingaporeSingapore
  2. 2.Program in Health Services and Systems ResearchDuke-NUS Medical SchoolSingaporeSingapore
  3. 3.Department of Rheumatology and ImmunologySingapore General HospitalSingaporeSingapore
  4. 4.Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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