Extent of and reasons for osteoporosis medication non-adherence among veterans and feasibility of a pilot text message reminder intervention



We determined the extent of and reasons for non-adherence to oral bisphosphonates among veterans and conducted a pilot text message reminder application aimed at the most commonly cited reason for non-adherence. The intervention was found to be acceptable and feasible.


To evaluate the extent of and reasons for non-adherence to oral bisphosphonates among veterans and to assess the acceptability and feasibility of a pilot text message reminder application.


We surveyed 105 veterans initiating oral bisphosphonates for osteoporosis/osteopenia within the prior 18 months utilizing a validated self-report measure adapted for osteoporosis. Additionally, we conducted a pilot text message reminder to determine feasibility in 12 veterans who were initiating or were currently non-adherent to oral bisphosphonates.


Of the 43 (40.9% response rate) completed surveys, the most common reasons for non-adherence were “I forgot” (37.5%), “I had other medications to take” (20.5%), “my bones are not weak” (18.4%), “I felt well” (18.4%), and “I worried about taking them for the rest of my life” (17.9%). Median MPR for the 49 (46.7%) non-adherent (MPR < 0.80) veterans was 0.35 (IQR 0.21–0.64). Of veterans offered a weekly automated text message reminder, 12 (50%) accepted. Nine of these 12 veterans reported that the text message reminders did “very well” at reminding them to take their medication and would recommend the application to other patients/family/friends. The median 6-month MPR for the reminder group was 0.96 (IQR 0.54–1.00).


Half the veterans in our sample were taking insufficient doses of oral bisphosphonates to attain the full benefit of fracture risk reduction. Reasons for poor adherence included forgetfulness, polypharmacy, and misconceptions about osteoporosis. A pilot text message reminder intervention targeted to one of the most commonly cited reasons was found to be acceptable and feasible among veterans.

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Research reported in this publication was supported by the National Institutes of Health under Award Numbers T32DK007012 (NS), I01 HX002512, and K24 AG049077 (CCE).

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Correspondence to Nicole Sagalla.

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Kenneth Lyles is a Trustee of the National Osteoporosis Foundation, a consultant for Health Stream, Viking, and founder and equity owner of Faculty Connection, LLC and BisCardia, Inc. Nicole Sagalla, Richard Lee, Julie Vognsen, and Cathleen Colón-Emeric declare that they have no conflict of interest.

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Sagalla, N., Lee, R., Lyles, K. et al. Extent of and reasons for osteoporosis medication non-adherence among veterans and feasibility of a pilot text message reminder intervention. Arch Osteoporos 16, 21 (2021). https://doi.org/10.1007/s11657-021-00889-7

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  • Adherence
  • Mobile health
  • MPR
  • Feasibility
  • Osteoporosis