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Insufficient persistence of and adherence to osteoporosis pharmacotherapy in Japan

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Abstract

Introduction

Only a few large-scale studies have examined the care gap in Japan. The aim of this study was to investigate the persistence of and adherence to osteoporosis pharmacotherapy in Japan.

Materials and Methods

The rates of continuation (persistence) of and adherence to osteoporosis pharmacotherapy were investigated using medical insurance data, issued from July 2013 to December 2018, from the medical care system for elderly individuals in Hokkaido, Japan.

Results

The study included 7918 male and 52,585 female patients. Persistence rates were 62.1% in the first year and 45.3% in the second year. There were 33,096 patients who discontinued medication; 8296 patients resumed medication during the observation period of 730 days. The median time to the discontinuation of medication for all the patients was 702 days. The 2-year medication possession ratio (MPR) was 63.8%; 30,989 patients (51.2%) had an MPR ≥ 80% and 20,788 (34.4%) had an MPR < 50%. Both the persistence and adherence were better in females than in males and worsened with increasing age. Comparisons of fracture history showed that persistence and MPR were higher in the no hip or vertebral fracture group, followed by hip fracture, vertebral fracture, and hip and vertebral fracture groups. Meanwhile, more patients in the hip fracture group had an MPR ≥ 80%.

Conclusion

Persistence of and adherence to osteoporotic pharmacotherapy are not very high in Japan. To bridge the care gap following osteoporosis pharmacotherapy, improvements are required for males, the elderly, and those with a history of vertebral fracture.

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Acknowledgements

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

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Asahi General Hospital, 477, Tomari, Asahimachi, Shimo-Niikawa-gun, Toyama, 939-0798, Japan

    Shinichi Nakatoh

  2. Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Kenji Fujimori

  3. Department of Hygiene and Public Health, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan

    Junko Tamaki

  4. Okimoto Clinic, 185-4, Kubi, Yutaka-machi, Kure, Hiroshima, 734-0304, Japan

    Nobukazu Okimoto

  5. Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Sumito Ogawa

  6. Department of Public Health, Faculty of Medicine, Kinki University, 377-2, Oono-Higashi, Osaka Sayama City, Osaka, 589-8511, Japan

    Masayuki Iki

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  1. Shinichi Nakatoh
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Contributions

SN: conception and design, analysis and interpretation of data, drafting the article, revising the article critically for important intellectual content, and final approval. KF had full access to all data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. JT, NO, MI, JO: conception and design, revising the article critically for important intellectual content, and final approval.

Corresponding author

Correspondence to Shinichi Nakatoh.

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Conflict of interest

S. Nakatoh has received lecture fees from Asahi-Kasei Pharmaceutical Co., Ltd.; Pfizer Japan Inc.; Amgen Astellas BioPharma K.K.; Astellas Pharma Inc.; Daiichi-Sankyo Co. Ltd.; and Eli Lilly Japan K.K. N. Okimoto has received consulting fees from Asahi-Kasei Pharmaceutical Co., Ltd and Teijin Pharma Ltd. N. Okimoto has received payments for lectures, including speakers’ bureau fees, from Asahi-Kasei Pharmaceutical Co., Ltd.; Amgen Astellas BioPharma K.K.; Astellas Pharma Inc.; Chugai Pharmaceutical Co.; Daiichi-Sankyo Co. Ltd.; Eisai Co., Ltd.; Eli Lilly Japan K.K.; Mitsubishi-Tanabe Pharma Corp.; Ono Pharmaceutical Co.; Pfizer Japan Inc.; and Teijin Pharma Ltd. The other authors have no conflicts of interest.

Ethical approval

This study was conducted according to the principles of the Declaration of Helsinki and approved by the institutional review board of the Asahi General Hospital (IRB No. 19-02) and the ethics committee of Tohoku University as “Examination of drug treatment compliance in osteoporosis using an electronic claim database” (2018-1-868). This study was a part of the “medical/nursing care information database development project,” in which the National Health Insurance Federation was instructed by the Hokkaido Government to construct the database at Tohoku University. The claim data, which were collected by KF, were provided by the governor with the approval by all municipal governments after anonymization in the National Health Insurance Federation.

Informed consent

The data in this study were completely anonymous; thus, informed consent was not required.

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Nakatoh, S., Fujimori, K., Tamaki, J. et al. Insufficient persistence of and adherence to osteoporosis pharmacotherapy in Japan. J Bone Miner Metab 39, 501–509 (2021). https://doi.org/10.1007/s00774-020-01188-w

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  • DOI: https://doi.org/10.1007/s00774-020-01188-w

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