Drugs & Aging

, Volume 28, Issue 4, pp 249–255 | Cite as

Understanding Patient Compliance and Persistence with Osteoporosis Therapy

Current Opinion


Chronic non-terminal diseases, including postmenopausal osteoporosis, are associated with poor treatment compliance and persistence. The longer a patient with osteoporosis complies and persists with treatment, the lower the risk of fracture. Retrospective studies with emphasis on real-world data have led to a greater understanding of the factors affecting medication compliance and persistence, and their association with improved treatment outcomes. However, these data do not contain information about patient choices of medication or patient commitment to particular medication regimens. Patient preferences can affect compliance and persistence behaviours. While recent evidence questions the importance of dosing regimen in patient preferences, other recent data show that medication efficacy and safety remain the most important determinants of patient preference. Informed patient decision making about treatment options, adverse effects and outcomes can have a beneficial impact on medication-taking behaviour. Healthcare professionals play a crucial role in the management of factors associated with poor compliance and persistence with osteoporosis therapies. Education about disease consequences and differences among treatment options, as well as treatment monitoring and positive reinforcement, are crucial to improving medication compliance and persistence in osteoporotic patients.


  1. 1.
    National Osteoporosis Foundation. Clinician’s guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation, 2010 [online]. Available from URL: http://www.nof.org/sites/default/files/pdfs/NOF_ClinicianGuide2009_v7.pdf [Accessed 2010 Dec 1]Google Scholar
  2. 2.
    Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007 Mar; 22(3): 465–75PubMedCrossRefGoogle Scholar
  3. 3.
    Black DM, Thompson DE, Bauer DC, et al., on behalf of the FIT Research Group. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. J Clin Endocrinol Metab 2000 Nov; 85(11): 4118–24PubMedCrossRefGoogle Scholar
  4. 4.
    Roux C, Seeman E, Eastell R, et al. Efficacy of risedronate on clinical vertebral fractures within six months. Curr Med Res Opin 2004 Apr; 20(4): 433–9PubMedCrossRefGoogle Scholar
  5. 5.
    Harrington JT, Ste-Marie LG, Brandi ML, et al. Risedronate rapidly reduces the risk for nonvertebral fractures in women with postmenopausal osteoporosis. Calcif Tissue Int 2004 Feb; 74(2): 129–35PubMedCrossRefGoogle Scholar
  6. 6.
    Felsenberg D, Miller P, Armbrecht G, et al. Oral ibandronate significantly reduces the risk of vertebral fractures of greater severity after 1, 2, and 3 years in postmenopausal women with osteoporosis. Bone 2005 Nov; 37(5): 651–4PubMedCrossRefGoogle Scholar
  7. 7.
    Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007 May; 356(18): 1809–22PubMedCrossRefGoogle Scholar
  8. 8.
    Harris ST, Watts NB, Genant HK, et al., on behalf of the Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 1999 Oct 13; 282(14): 1344–52PubMedCrossRefGoogle Scholar
  9. 9.
    McClung MR, Geusens P, Miller PD, et al., on behalf of the Hip Intervention Program Study Group. Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 2001 Feb 1; 344(5): 333–40PubMedCrossRefGoogle Scholar
  10. 10.
    Black DM, Cummings SR, Karpf DB, et al., on behalf of the Fracture Intervention Trial Research Group. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 1996 Dec 7; 348(9041): 1535–41PubMedCrossRefGoogle Scholar
  11. 11.
    Chesnut III CH, Skag A, Christiansen C, et al. Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 2004 Aug; 19(8): 1241–9CrossRefGoogle Scholar
  12. 12.
    Tosteson AN, Grove MR, Hammond CS, et al. Early discontinuation of treatment for osteoporosis. Am J Med 2003 Aug 15; 115(3): 209–16PubMedCrossRefGoogle Scholar
  13. 13.
    McCombs JS, Thiebaud P, McLaughlin-Miley C, et al. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 2004 Jul 15; 48(3): 271–87PubMedCrossRefGoogle Scholar
  14. 14.
    Siris ES, Harris ST, Rosen CJ, et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 2006 Aug; 81(8): 1013–22PubMedCrossRefGoogle Scholar
  15. 15.
    Hamilton B, McCoy K, Taggart H. Tolerability and compliance with risedronate in clinical practice. Osteoporos Int 2003 May; 14(3): 259–62PubMedGoogle Scholar
  16. 16.
    Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health 2008 Jan-Feb; 11(1): 44–7PubMedCrossRefGoogle Scholar
  17. 17.
    Peterson AM, Nau DP, Cramer JA, et al. A checklist for medication compliance and persistence studies using retrospective databases. Value Health 2007; 10(1): 3–12PubMedCrossRefGoogle Scholar
  18. 18.
    Cadarette SM, Burden AM. Measuring and improving adherence to osteoporosis pharmacotherapy. Curr Opin Rheumatol. 2010; 22: 397–403PubMedCrossRefGoogle Scholar
  19. 19.
    Siris ES, Selby PL, Saag KG, et al. Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 2009; 122: S3PubMedCrossRefGoogle Scholar
  20. 20.
    Crystal S, Akincigil A, Bilder S, et al. Studying prescription drug use and outcomes with Medicaid claims data strengths, limitations, and strategies. Med Care 2007 Oct; 45(10 Suppl.): S58–65PubMedCrossRefGoogle Scholar
  21. 21.
    Silverman S, Gold DT. Compliance and persistence with osteoporosis medications: a critical review of the literature. Rev Endocr Metab Disord 2010 Dec; 11(4): 275–80PubMedCrossRefGoogle Scholar
  22. 22.
    Cramer JA, Silverman SL, Gold DT. Methodological considerations in using claims databases to evaluate persistence with bisphosphonates for osteoporosis. Curr Med Res Opin 2007 Oct; 23(10): 2369–77PubMedCrossRefGoogle Scholar
  23. 23.
    Motheral BR, Fairman KA. The use ofclaims databases for outcomes research: rationale, challenges, and strategies. Clin Ther 1997 Mar-Apr; 19(2): 346–66PubMedCrossRefGoogle Scholar
  24. 24.
    Cramer JA, Gold DT, Silverman SL, et al. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 2007 Aug; 18(8): 1023–31PubMedCrossRefGoogle Scholar
  25. 25.
    Kothawala P, Badamgarav E, Ryu S, et al. Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc 2007; 82(12): 1493–501PubMedCrossRefGoogle Scholar
  26. 26.
    Imaz I, Zegarra P, Gonzalez-Enriquez J, et al. Poor bisphosphonate adherence for treatment of osteoporosis increases fracture risk: systematic review and meta-analysis. Osteoporos Int 2010 Nov; 21(11): 1943–51PubMedCrossRefGoogle Scholar
  27. 27.
    Emkey RD, Ettinger M. Improving compliance and persistence with bisphosphonate therapy for osteoporosis. Am J Med 2006 Apr; 119 (4 Suppl. 1): S18–24PubMedCrossRefGoogle Scholar
  28. 28.
    Papaioannou A, Kennedy CC, Dolovich L, et al. Patient adherence to osteoporosis medications: problems, consequences and management strategies. Drugs Aging 2007; 24(1): 37–55PubMedCrossRefGoogle Scholar
  29. 29.
    Yood RA, Mazor KM, Andrade SE, et al. Patient decision to initiate therapy for osteoporosis: the influence of knowledge and beliefs. J Gen Intern Med 2008 Nov; 23(11): 1815–21PubMedCrossRefGoogle Scholar
  30. 30.
    Buist DS, LaCroix AZ, Black DM, et al. Inclusion of older women in randomized clinical trials: factors associated with taking study medication in the fracture intervention trial. J Am Geriatr Soc 2000 Sep; 48(9): 1126–31PubMedGoogle Scholar
  31. 31.
    Downey TW, Foltz SH, Boccuzi SJ, et al. Adherence and persistence associated with the pharmacologic treatment of osteoporosis in a managed care setting. South Med J 2006; 99: 570–5PubMedCrossRefGoogle Scholar
  32. 32.
    Elliott RA, Shinogle JA, Peele P, et al. Understanding medication compliance and persistence from an economics perspective. Value Health 2008 Jul-Aug; 11(4): 600–10PubMedCrossRefGoogle Scholar
  33. 33.
    Kamatari M, Koto S, Ozawa N, et al. Factors affecting long-term compliance of osteoporotic patients with bisphosphonate treatment and QOL assessment in actual practice: alendronate and risedronate. J Bone Miner Metab 2007; 25(5): 302–9PubMedCrossRefGoogle Scholar
  34. 34.
    Doggrell SA. Adherence to medicines in the older-aged with chronic conditions: does intervention by an allied health professional help? Drugs Aging 2010; 27(3): 239–54PubMedCrossRefGoogle Scholar
  35. 35.
    Penning-van Beest FJ, Goettsch WG, Erkens JA, et al. Determinants of persistence with bisphosphonates: a study in women with postmenopausal osteoporosis. Clin Ther 2006 Feb; 28(2): 236–42PubMedCrossRefGoogle Scholar
  36. 36.
    Recker RR, Gallagher R, MacCosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005 Jul; 80(7): 856–61PubMedCrossRefGoogle Scholar
  37. 37.
    Cooper A, Drake J, Brankin E, et al., on behalf of the PERSIST Investigators. Treatment persistence with once-monthly ibandronate and patient support vs. once-weekly alendronate: results from the PERSIST study. Int J Clin Pract 2006 Aug; 60(8): 896–905PubMedCrossRefGoogle Scholar
  38. 38.
    Gold DT, Safi W, Trinh H. Patient preference and adherence: comparative US studies between two bisphosphonates, weekly risedronate and monthly ibandronate. Curr Med Res Opin 2006 Dec; 22(12): 2383–91PubMedCrossRefGoogle Scholar
  39. 39.
    Gold D, Borisov N, Safi W. Patient refill behavior among select daily, weekly, monthly, and annual dosing regimens [abstract no. M373]. The American Society for Bone and Mineral Research 30th Annual Meeting; 2008 Sep 12–16; Montréal (QC)Google Scholar
  40. 40.
    Emkey R, Koltun W, Beusterien K, et al. Patient preference for once-monthly ibandronate versus once-weekly alendronate in a randomized, open-label, cross-over trial: the Boniva Alendronate Trial in Osteoporosis (BALTO). Curr Med Res Opin 2005 Dec; 21(12): 1895–903PubMedCrossRefGoogle Scholar
  41. 41.
    Weiss TW, Gold DT, Silverman SL, et al. An evaluation of patient preferences for osteoporosis medication attributes: results from the PREFER-US study. Curr Med Res Opin 2006 May; 22(5): 949–60PubMedCrossRefGoogle Scholar
  42. 42.
    Keen R, Jodar E, Iolascon G, et al. European women’s preference for osteoporosis treatment: influence of clinical effectiveness and dosing frequency. Curr Med Res Opin 2006 Dec; 22(12): 2375–81PubMedCrossRefGoogle Scholar
  43. 43.
    Osteoporosis clinical updates: compliance and persistence with osteoporosis therapies. Washington, DC: National Osteoporosis Foundation, 2009 Jan [online]. Available form URL: [Accessed 2010 Nov 16]
  44. 44.
    Solomon DH, Gleeson T, Iversen M, et al. A blinded randomized controlled trial of motivational interviewing to improve adherence with osteoporosis medications: design of the OPTIMA trial. Osteoporos Int 2010 Jan; 21(1): 137–44PubMedCrossRefGoogle Scholar
  45. 45.
    Clowes JA, Peel NF, Eastell R. The impact of monitoring on adherence and persistence with antiresorptive treatment for osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 2004 Mar; 89(3): 1117–23PubMedCrossRefGoogle Scholar
  46. 46.
    Delmas PD, Vrijens B, Eastell R, et al., on behalf of the Improving Measurements of Persistence on Actonel Treatment (IMPACT) Investigators. Effect of monitoring bone turnover markers on persistence with risedronate treatment of postmenopausal osteoporosis. J Clin Endocrinol Metab 2007 Apr; 92(4): 1296–304PubMedCrossRefGoogle Scholar
  47. 47.
    Curtis JR, Xi J, Westfall AO, et al. Improving the prediction of medication compliance: the example of bisphosphonates for osteoporosis. Med Care 2009 Mar; 47(3): 334–41PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  1. 1.Duke University Medical CenterDurhamUSA

Personalised recommendations