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Osteoporosis medication adherence tools: a systematic review

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Abstract

Poor adherence reduces the effectiveness of osteoporosis treatment, resulting in lower bone mineral density and subsequently higher fracture rates. Reliable and practical tools are needed to measure medication adherence. The aim of this systematic review was to find osteoporosis medication adherence measurement tools and assess their applicability. Osteoporosis adherence measurement tools and all their related keywords in PubMed, Embase, Web of Science, and Scopus databases were searched on 4 December, 2022. After excluding duplicates in the Endnote software, two researchers independently investigated the remaining articles and included all those that used a method for measuring adherence to osteoporosis pharmacotherapy. Articles that did not specify the medications evaluated or if the primary focus was not adherence excluded. Two common measures of adherence, i.e., compliance and persistence were included. Four separate tables were designed, one for direct methods, one for formulas, one for questionnaires, and one for electronic methods of measuring adherence to treatment. Quality assessment was performed for selected articles by the Newcastle-Ottawa Quality Assessment Scale (NOS). A total of 3821 articles were found, of which 178 articles met the inclusion and exclusion criteria. In general, five types of methods were observed to measure medication adherence of osteoporosis, including direct methods (n = 4), pharmacy records (n = 17), questionnaires (n = 13), electronic methods (n = 1), and tablet counting (n = 1). The most commonly used adherence measurement tool, based on pharmacy records, was medication possession ratio (MPR). Among questionnaires, Morisky Medication Adherence Scale was mostly used. Our findings show what tools have been used to measure medication adherence in osteoporosis patients. Among these tools, direct methods and electronic methods are the most accurate methods. However, due to their high cost, they are practically not used in measuring osteoporosis medication adherence. Questionnaires are the most popular among them and are mostly used in osteoporosis.

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Data availability

All data supporting the findings of this study are available within the paper and its Supplementary Information.

Abbreviations

WHO:

World Health Organization

BMD:

Bone mineral density

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PDC:

Proportion of days covered

MPR:

Medication possession ratio

MEMS:

Medication event monitoring systems

MMAS:

Morisky Medication Adherence Scale

OS-MMAS:

Osteoporosis Specific Morisky Medication Adherence Scale

MARS:

Medication Adherence Rating Scale

NOS:

Newcastle-Ottawa Quality Assessment Scale

NTX:

Urinary N-terminal cross-linked telopeptide of type 1 collagen

CTX:

C-terminal cross-linked telopeptide of type 1 collagen

CMA:

Continuous measure of Medication Acquisition

SEOMA:

Self-efficacy expectations for osteoporosis medication adherence

OEOMA:

Outcome expectations of osteoporosis medication adherence

ADEOS:

Adherence evaluation of osteoporosis treatment

TSQM:

Treatment Satisfaction Questionnaire for Medication

BMQ:

Beliefs about Medicine Questionnaire

OPQ:

Osteoporosis Questionnaire

SRMA:

Self-reported medication adherence tools

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Acknowledgements

The authors would like to thank the authors of the studies included in this systematic review. The authors also are grateful for the support from Osteoporosis Research center.

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Authors and Affiliations

  1. Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Elahe Hesari, Mahnaz Sanjari, Mohammad Javad Mansourzadeh, Noushin Fahimfar, Kazem Khalagi, Arash Ghazbani & Afshin Ostovar

  2. School of Public Health, Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran

    Elahe Hesari, Noushin Fahimfar, Arash Ghazbani & Akbar Fotouhi

  3. Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammad Javad Mansourzadeh

  4. Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Kazem Khalagi

  5. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Afshin Ostovar

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  1. Elahe Hesari
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Correspondence to Mahnaz Sanjari.

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Hesari, E., Sanjari, M., Mansourzadeh, M.J. et al. Osteoporosis medication adherence tools: a systematic review. Osteoporos Int 34, 1535–1548 (2023). https://doi.org/10.1007/s00198-023-06789-5

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