Skip to main content

Advertisement

SpringerLink
Log in

Persistence and compliance to osteoporosis therapy in a fracture liaison service: a prospective cohort study

  • Original Article
  • Published:
Archives of Osteoporosis Aims and scope Submit manuscript

Abstract

Summary

Persistence and compliance to osteoporosis medications aiming to prevent fragility fractures are essential for fracture prevention, but are suboptimal in the population. A Fracture Liaison Service with a systematic follow-up led to ongoing therapy and optimal drug compliance for more than half of treated patients over 2 years.

Purpose

Fracture Liaison Services (FLS) have the potential to improve persistence and compliance to osteoporosis therapy. We aimed to assess patterns of drug use in a high-level intervention FLS.

Methods

Women and men (> 40 years) with a fragility fracture were recruited in a FLS, where osteoporosis therapy was prescribed if appropriate. Based on claims data, patients who filled their prescription in the 3-month period following baseline were selected. The 1- and 2-year persistence rates were measured using survival analysis. In non-persistent subjects, 1-year treatment re-initiation was measured. The 1- and 2-year compliance levels were measured, using the proportion of days covered (PDC > 80% = compliant). Regression analyses were performed to identify predictors of non-persistence/compliance.

Results

Out of 332 subjects with complete drug insurance coverage, 297 (89.5%) were prescribed osteoporosis therapy by the FLS, and 275 (92.6%) were dispensed. Two hundred sixty participants (86.9% female; mean age 65.6 years) were selected for having filled a prescription inside 3 months after baseline. The 1- and 2-year persistence rates were 66.4% and 55.6%, respectively. Treatment re-initiation was observed in 56% of non-persistent patients. PDC was > 80% in 64.2% for 1 year and 62.5% for 2 years. Older and younger age, smoking, higher spine bone mineral density, lower major FRAX risk, and missing follow-up visits were predictors of non-persistence and/or non-compliance.

Conclusions

After 2 years in a high-level intervention FLS, more than half the treated participants were persistent and compliant to treatment. Comparative effectiveness studies must be undertaken to determine whether this intervention is an improvement over usual care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nih Consensus Development Panel on Osteoporosis Prevention D, Therapy (2001) Osteoporosis prevention, diagnosis, and therapy. JAMA 285(6):785–795

    Article  Google Scholar 

  2. Maraka S, Kennel KA (2015) Bisphosphonates for the prevention and treatment of osteoporosis. BMJ 351:h3783. https://doi.org/10.1136/bmj.h3783

    Article  CAS  PubMed  Google Scholar 

  3. Saito T, Sterbenz JM, Malay S, Zhong L, MacEachern MP, Chung KC (2017) Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int 28(12):3289–3300. https://doi.org/10.1007/s00198-017-4175-0

    Article  CAS  PubMed  Google Scholar 

  4. Sattari M, Cauley JA, Garvan C, Johnson KC, LaMonte MJ, Li W, Limacher M, Manini T, Sarto GE, Sullivan SD, Wactawski-Wende J, Beyth RJ (2017) Osteoporosis in the Women’s Health Initiative: another treatment gap? Am J Med 130(8):937–948. https://doi.org/10.1016/j.amjmed.2017.02.042

    Article  PubMed  Google Scholar 

  5. Bessette L, Ste-Marie LG, Jean S, Davison KS, Beaulieu M, Baranci M, Bessant J, Brown JP (2008) The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 19(1):79–86. https://doi.org/10.1007/s00198-007-0426-9

    Article  CAS  PubMed  Google Scholar 

  6. Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving. Osteoporos Int 23(5):1623–1629. https://doi.org/10.1007/s00198-011-1630-1

    Article  CAS  PubMed  Google Scholar 

  7. Institut national d’excellence en santé et en services sociaux (INESSS) (2014) Portrait de l’usage des bisphosphonates et du dénosumab chez les personnes de 50 ans ou plus souffrant d’ostéoporose couvertes par le régime public d’assurance médicaments. Portrait d’usage rédigé par Éric Tremblay. Québec, Qc : INESSS

  8. Blouin J, Dragomir A, Ste-Marie LG, Fernandes JC, Perreault S (2007) Discontinuation of antiresorptive therapies: a comparison between 1998-2001 and 2002-2004 among osteoporotic women. J Clin Endocrinol Metab 92(3):887–894. https://doi.org/10.1210/jc.2006-1856

    Article  CAS  PubMed  Google Scholar 

  9. Weycker D, Macarios D, Edelsberg J, Oster G (2007) Compliance with osteoporosis drug therapy and risk of fracture. Osteoporos Int 18(3):271–277. https://doi.org/10.1007/s00198-006-0230-y

    Article  CAS  PubMed  Google Scholar 

  10. Soong YK, Tsai KS, Huang HY, Yang RS, Chen JF, Wu PC, Huang KE (2013) Risk of refracture associated with compliance and persistence with bisphosphonate therapy in Taiwan. Osteoporos Int 24(2):511–521. https://doi.org/10.1007/s00198-012-1984-z

    Article  CAS  PubMed  Google Scholar 

  11. Penning-van Beest FJ, Erkens JA, Olson M, Herings RM (2008) Loss of treatment benefit due to low compliance with bisphosphonate therapy. Osteoporos Int 19(4):511–517. https://doi.org/10.1007/s00198-007-0466-1

    Article  CAS  PubMed  Google Scholar 

  12. Silverman S, Gold DT (2010) Compliance and persistence with osteoporosis medications: a critical review of the literature. Rev Endocr Metab Disord 11(4):275–280. https://doi.org/10.1007/s11154-010-9138-0

    Article  PubMed  PubMed Central  Google Scholar 

  13. Blouin J, Dragomir A, Moride Y, Ste-Marie LG, Fernandes JC, Perreault S (2008) Impact of noncompliance with alendronate and risedronate on the incidence of nonvertebral osteoporotic fractures in elderly women. Br J Clin Pharmacol 66(1):117–127. https://doi.org/10.1111/j.1365-2125.2008.03178.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Walters S, Khan T, Ong T, Sahota O (2017) Fracture liaison services: improving outcomes for patients with osteoporosis. Clin Interv Aging 12:117–127. https://doi.org/10.2147/CIA.S85551

    Article  PubMed  PubMed Central  Google Scholar 

  15. Osuna PM, Ruppe MD, Tabatabai LS (2017) Fracture liaison services: multidisciplinary approaches to secondary fracture prevention. Endocr Pract 23(2):199–206. https://doi.org/10.4158/EP161433.RA

    Article  PubMed  Google Scholar 

  16. Aizer J, Bolster MB (2014) Fracture liaison services: promoting enhanced bone health care. Curr Rheumatol Rep 16(11):455. https://doi.org/10.1007/s11926-014-0455-2

    Article  PubMed  Google Scholar 

  17. Wu C-H, Tu S-T, Chang Y-F, Chan D-C, Chien J-T, Lin C-H, Singh S, Dasari M, Chen J-F, Tsai K-S (2018) Fracture liaison services improve outcomes of patients with osteoporosis-related fractures: a systematic literature review and meta-analysis. Bone 111:92–100. https://doi.org/10.1016/j.bone.2018.03.018

    Article  PubMed  Google Scholar 

  18. Jaleel A, Saag KG, Danila MI (2018) Improving drug adherence in osteoporosis: an update on more recent studies. Ther Adv Musculoskelet Dis 10(7):141–149. https://doi.org/10.1177/1759720x18785539

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ganda K, Schaffer A, Pearson S, Seibel MJ (2014) Compliance and persistence to oral bisphosphonate therapy following initiation within a secondary fracture prevention program: a randomised controlled trial of specialist vs. non-specialist management. Osteoporos Int 25(4):1345–1355. https://doi.org/10.1007/s00198-013-2610-4

    Article  CAS  PubMed  Google Scholar 

  20. White HJ, Bettiol SS, Perera R, Roberts NW, Javaid MK, Farmer AJ (2010) A systematic review assessing the effectiveness of interventions to improve persistence with anti-resorptive therapy in women at high risk of clinical fracture. Fam Pract 27(6):593–603. https://doi.org/10.1093/fampra/cmq060

    Article  CAS  PubMed  Google Scholar 

  21. Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24(2):393–406. https://doi.org/10.1007/s00198-012-2090-y

    Article  CAS  PubMed  Google Scholar 

  22. Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182(17):1864–1873. https://doi.org/10.1503/cmaj.100771

    Article  PubMed  PubMed Central  Google Scholar 

  23. Senay A, Perreault S, Delisle J, Morin SN, Raynauld JP, Banica A, Troyanov Y, Beaumont P, Jodoin A, Laflamme GY, Leduc S, Mac-Thiong JM, Nguyen H, Ranger P, Rouleau DM, Fernandes JC (2019) Rationale, study design, and descriptive data of the lucky bone fracture liaison service. Arch Osteoporos 14(1):19. https://doi.org/10.1007/s11657-019-0571-8

    Article  PubMed  Google Scholar 

  24. Lentle B, Cheung AM, Hanley DA, Leslie WD, Lyons D, Papaioannou A, Atkinson S, Brown JP, Feldman S, Hodsman AB, Jamal AS, Josse RG, Kaiser SM, Kvern B, Morin S, Siminoski K (2011) Osteoporosis Canada 2010 guidelines for the assessment of fracture risk. Can Assoc Radiol J 62(4):243–250. https://doi.org/10.1016/j.carj.2011.05.001

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kanis JA, Hans D, Cooper C, Baim S, Bilezikian JP, Binkley N, Cauley JA, Compston JE, Dawson-Hughes B, El-Hajj Fuleihan G, Johansson H, Leslie WD, Lewiecki EM, Luckey M, Oden A, Papapoulos SE, Poiana C, Rizzoli R, Wahl DA, McCloskey EV (2011) Interpretation and use of FRAX in clinical practice. Osteoporos Int 22(9):2395–2411. https://doi.org/10.1007/s00198-011-1713-z

    Article  CAS  PubMed  Google Scholar 

  26. Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167 (10 Suppl):S1–34

  27. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359(9321):1929–1936. https://doi.org/10.1016/s0140-6736(02)08761-5

    Article  PubMed  Google Scholar 

  28. Réseau Québécois de Recherche sur les Médicaments (RQRM). reMed : data registry for prescribed medications/Banque de données Sur les médicaments d'ordonnance. www.rqrm.ca/plateformes/optimisation-de-l-usage/64-4-remed-data-registry-for-prescribed-medications-banque-de-donnees-sur-les-medicaments-d-ordonnance.html. Accessed 5 June 2018

  29. Tamblyn R, Lavoie G, Petrella L, Monette J (1995) The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 48(8):999–1009

    Article  CAS  PubMed  Google Scholar 

  30. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK (2008) Medication compliance and persistence: terminology and definitions. Value Health 11(1):44–47. https://doi.org/10.1111/j.1524-4733.2007.00213.x

    Article  PubMed  Google Scholar 

  31. Cadarette SM, Burden AM (2010) Measuring and improving adherence to osteoporosis pharmacotherapy. Curr Opin Rheumatol 22(4):397–403. https://doi.org/10.1097/BOR.0b013e32833ac7fe

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hansen RA, Kim MM, Song L, Tu W, Wu J, Murray MD (2009) Comparison of methods to assess medication adherence and classify nonadherence. Ann Pharmacother 43(3):413–422. https://doi.org/10.1345/aph.1L496

    Article  PubMed  Google Scholar 

  33. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  34. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA (2004) New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 57(12):1288–1294. https://doi.org/10.1016/j.jclinepi.2004.03.012

    Article  PubMed  Google Scholar 

  35. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

    Article  CAS  PubMed  Google Scholar 

  36. Harel O, Mitchell EM, Perkins NJ, Cole SR, Tchetgen Tchetgen EJ, Sun B, Schisterman EF (2018) Multiple imputation for incomplete data in epidemiologic studies. Am J Epidemiol 187(3):576–584. https://doi.org/10.1093/aje/kwx349

    Article  PubMed  Google Scholar 

  37. Nayak S, Greenspan SL (2018) How can we improve osteoporosis care? A systematic review and meta-analysis of the efficacy of quality improvement strategies for osteoporosis. J Bone Miner Res 33(9):1585–1594. https://doi.org/10.1002/jbmr.3437

    Article  PubMed  Google Scholar 

  38. Naranjo A, Ojeda-Bruno S, Bilbao-Cantarero A, Quevedo-Abeledo JC, Diaz-Gonzalez BV, Rodriguez-Lozano C (2015) Two-year adherence to treatment and associated factors in a fracture liaison service in Spain. Osteoporos Int 26(11):2579–2585. https://doi.org/10.1007/s00198-015-3185-z

    Article  CAS  PubMed  Google Scholar 

  39. Durden E, Pinto L, Lopez-Gonzalez L, Juneau P, Barron R (2017) Two-year persistence and compliance with osteoporosis therapies among postmenopausal women in a commercially insured population in the United States. Arch Osteoporos 12(1):22. https://doi.org/10.1007/s11657-017-0316-5

    Article  PubMed  PubMed Central  Google Scholar 

  40. McAlister FA, Ye C, Beaupre LA, Rowe BH, Johnson JA, Bellerose D, Hassan I, Majumdar SRJOI (2019) Adherence to osteoporosis therapy after an upper extremity fracture: a pre-specified substudy of the C-STOP randomized controlled trial 30 (1):127–134. doi:https://doi.org/10.1007/s00198-018-4702-7

  41. Yeam CT, Chia S, Tan HCC, Kwan YH, Fong W, Seng JJB (2018) A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporos Int 29(12):2623–2637. https://doi.org/10.1007/s00198-018-4759-3

    Article  CAS  PubMed  Google Scholar 

  42. Bessette L, Jean S, Davison KS, Roy S, Ste-Marie LG, Brown JP (2009) Factors influencing the treatment of osteoporosis following fragility fracture. Osteoporos Int 20(11):1911–1919. https://doi.org/10.1007/s00198-009-0898-x

    Article  CAS  PubMed  Google Scholar 

  43. Ding R, Zeger SL, Steinwachs DM, Ortmann MJ, McCarthy ML (2013) The validity of self-reported primary adherence among Medicaid patients discharged from the emergency department with a prescription medication. Ann Emerg Med 62(3):225–234. https://doi.org/10.1016/j.annemergmed.2013.01.026

    Article  PubMed  Google Scholar 

  44. Peeters GM, Tett SE, Dobson AJ, Mishra GD (2013) Validity of self-reported osteoporosis in mid-age and older women. Osteoporos Int 24(3):917–927. https://doi.org/10.1007/s00198-012-2033-7

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank participants, orthopedic clinics’ staff, and research assistants involved in this study. The authors also thank the Régie de l’assurance maladie du Québec for the help with administrative data. A very special thanks to Andreea Banica, BScN, the research clinical nurse for this study, Marc Dorais, MSc, for his help with statistical programming, and Kathleen Beaumont for her assistance in reviewing this manuscript.

Funding

This study was funded by orthopedic funds from the Hôpital du Sacré-Coeur de Montréal research center in Montréal, Canada, grants from Eli Lilly Canada, the Sanofi Canada Chair of drug usage, and the Réseau Québécois de Recherche sur les Médicaments (RQRM). Senay received a doctoral training award from the Fonds de Recherche du Québec - Santé (FRQS).

Author information

Authors and Affiliations

  1. Faculty of Pharmacy, Université de Montréal, C. P. 6128, Succursale Centre-Ville, Montréal, Québec, H3C 3J7, Canada

    Andréa Senay & Sylvie Perreault

  2. CIUSSS Nord de l’Ile de Montréal, Hôpital du Sacré-Coeur de Montréal, 5400 bl. Gouin ouest, Montréal, Quebec, H4J 1C5, Canada

    Andréa Senay, Julio C. Fernandes & Josée Delisle

  3. Faculty of Medicine, Université de Montréal, 2900 bl. Édouard-Montpetit, Montréal, Quebec, H3T 1J4, Canada

    Julio C. Fernandes

  4. CIUSSS Nord de l’Ile de Montréal, Hôpital Jean-Talon, 1385 rue Jean-Talon est, Montréal, Quebec, H2E 1S6, Canada

    Julio C. Fernandes & Josée Delisle

  5. Department of Medicine, Center for Outcomes and Evaluation, McGill University, 5252 de Maisonneuve ouest, Montréal, Quebec, H4A 3S5, Canada

    Suzanne N. Morin

  6. Sanofi Aventis endowment Research Chair in Optimal Drug Use, Université de Montréal, Montréal, Quebec, Canada

    Sylvie Perreault

Authors
  1. Andréa Senay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julio C. Fernandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josée Delisle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Suzanne N. Morin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sylvie Perreault
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sylvie Perreault.

Ethics declarations

Conflict of interest

Senay and Perreault declare that they have no conflict of interest. Delisle reports support for personal fees from Amgen Canada and Eli Lilly outside of the conducted work. Morin reports research grants from Amgen Canada and Merck outside of the conducted work. Fernandes reports grants from Eli Lilly during the conduct of this study, and grants from Baxter outside of the conducted work.

All procedures performed in this study involving human participants were in accordance with the ethical standards of the CIUSSS Nord de l’Ile de Montréal ethic research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 629 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Senay, A., Fernandes, J.C., Delisle, J. et al. Persistence and compliance to osteoporosis therapy in a fracture liaison service: a prospective cohort study. Arch Osteoporos 14, 87 (2019). https://doi.org/10.1007/s11657-019-0633-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11657-019-0633-y

Keywords

Search

Navigation