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Improving adherence to and persistence with oral therapy of osteoporosis

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Abstract

Summary

Osteoporosis treatment has low adherence and persistence. This study evaluated if greater patient involvement could improve them. At 12 months, only 114 out of 344 participants were “fully adherent and persistent” (all drug doses taken throughout the study). Only frequency of drug administration had a significant influence on adherence.

Introduction

Osteoporosis affects millions of individuals worldwide. There are now several effective drugs, but adherence to and persistence with treatment are low. This 12-month multicenter, prospective, randomized study evaluated the efficacy of two different methods aimed at improving adherence and persistence through greater patient involvement, compared with standard clinical practice.

Methods

Three hundred thirty-four post-menopausal women, receiving an oral prescription for osteoporosis for the first time, were recruited and randomized into three groups: group 1 (controls, managed according to standard clinical practice) and groups 2 and 3 (managed with greater patient and caregiver involvement and special reinforcements: group 2, instructed to use several different “reminders”; group 3, same “reminders” as group 2, plus regular phone calls from and meetings at the referring Center). All enrolled women had two visits (baseline and 12 months).

Results

Of 334 enrolled women, 247 (74 %) started the prescribed therapy. Of those who started, 219 (88.7 %) persisted in therapy for at least 10 months. At final evaluation, only 114 women were considered as “fully adherent and persistent” (all doses taken throughout the 12 months). There were no significant differences regarding “full adherence” among the three randomized groups. The frequency of drug administration had a significant influence: weekly administration had a >5-fold higher adherence and monthly administration an 8-fold higher adherence (p < 0.0001) than daily administration.

Conclusions

The special effort of devising and providing additional reminders did not prove effective. Additional interventions during the follow-up, including costly interventions such as phone calls and educational meetings, did not provide significant advantages.

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Abbreviations

AIDS:

Acquired immunodeficiency syndrome

BMD:

Bone mineral density

CI:

Confidence interval

DXA:

Dual X-ray absorptiometry

EU:

European Union

FDA:

Food and Drug Administration

HRT:

Hormone replacement therapy

LSR:

Least significant response

NTx:

N-terminal telopeptide of type 1 collagen

OC:

Osteocalcin

OR:

Odds ratio

SERMs:

Selective estrogen receptor modulators

WHO:

World Health Organization

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Acknowledgments

The study was funded by the Agenzia Italiana del Farmaco (AIFA), www.agenziafarmaco.gov.it/. The authors thank Donatella Casati and Claudio Cappuccino of the Lega Italiana Osteoporosi (LIOS) onlus for helping with the preparation of educational materials and Cristina Spinazzola for the data entry and management.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, Via L. Ariosto 13, 20145, Milano, Italy

    M. L. Bianchi, S. Vai, F. Broggi & M. Croci

  2. Unit of Biometrics and Medical Statistics, Department of Biomedical and Clinical Sciences, Ospedale Luigi Sacco, University of Milano, Milano, Italy

    P. Duca

  3. Casa Sollievo della Sofferenza IRCCS, S. Giovanni Rotondo, University of Foggia, Foggia, Italy

    G. Guglielmi, R. Viti, C. Battista, A. Scillitani & S. Muscarella

  4. Department of Medicine, Division of Endocrinology, Bone Metabolic Diseases Service, University of Padova, Padua, Italy

    G. Luisetto & V. Camozzi

  5. Department of Internal Medicine, Endocrine-Metabolic Science and Biochemistry, University of Siena, Siena, Italy

    R. Nuti, C. Caffarelli & S. Gonnelli

  6. Department of Radiological Science, Policlinico Umberto I, University La Sapienza, Rome, Italy

    C. Albanese & V. De Tullio

  7. Department of Medical Science - Geriatrics and Metabolic Bone Diseases, University of Torino, Turin, Italy

    G. Isaia & P. D’Amelio

Authors
  1. M. L. Bianchi
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  2. P. Duca
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  3. S. Vai
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  4. G. Guglielmi
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  5. R. Viti
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  6. C. Battista
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  7. A. Scillitani
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  8. S. Muscarella
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  9. G. Luisetto
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  10. V. Camozzi
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  11. R. Nuti
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  12. C. Caffarelli
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  13. S. Gonnelli
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  14. C. Albanese
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  15. V. De Tullio
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  16. G. Isaia
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  17. P. D’Amelio
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  18. F. Broggi
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  19. M. Croci
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Corresponding author

Correspondence to M. L. Bianchi.

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Bianchi, M.L., Duca, P., Vai, S. et al. Improving adherence to and persistence with oral therapy of osteoporosis. Osteoporos Int 26, 1629–1638 (2015). https://doi.org/10.1007/s00198-015-3038-9

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  • DOI: https://doi.org/10.1007/s00198-015-3038-9

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