A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary

Abstract

This study assessed persistence and compliance with anti-osteoporosis therapies, and associations between compliance and clinical outcomes (fracture, fracture-related hospitalization and death), in Hungarian women with postmenopausal osteoporosis. The study used the Hungarian National Health Insurance Fund Administration database and included women with PMO aged at least 50 years, for whom a prescription for anti-osteoporosis medication had been filled between 1 January 2004 and 31 December 2013 (index event). Persistence (prescription refilled within 8 weeks of the end of the previous supply) was evaluated over 2 years; good compliance (medication possession ratio ≥ 80 %) was evaluated at 1 year. Associations between compliance and clinical outcomes (data collected for up to 6 years) were assessed with adjustment for baseline covariates. A total of 296,300 women met the inclusion criteria (524,798 index events). Persistence and compliance were higher for less frequent and parenteral therapies (1- and 2-year persistence: half-yearly [parenteral] vs. daily/weekly/monthly [oral and parenteral], 81 and 38 % vs. 21-34 and 10-18 %, respectively; parenteral vs. oral, 75 and 36 % vs. 32 and 16 %; good compliance: half-yearly vs. daily/weekly/monthly, 70 vs. 24-39 %; parenteral vs. oral 78 vs. 36 %). Good compliance significantly reduced the risks of fracture, fracture-related hospitalization and death (relative risk vs. non-compliance [95 % confidence interval]: 0.77 [0.70-0.84], 0.72 [0.62-0.85] and 0.57 [0.51-0.64], respectively; P < 0.01). Improving compliance through long-interval parenteral therapies may result in clinical benefits for patients.

Gender- and age-related treatment compliance in patients with osteoporosis in Germany

“…Corroborating previous results, good compliance significantly reduced the risk of fracture (OR =0.77), fracture-related hospitalization (OR =0.72), and death (OR =0.57). In line with the findings of Lakatos et al,11 the present retrospective study found that injectable and IV drugs had a positive effect on compliance when compared to oral drugs. This finding reflects the fact that IV drugs may involve fewer side effects than oral therapies, particularly gastrointestinal side effects, which are very common in individuals with osteoporosis who are being treated with oral bisphosphonates 24.…”

“…Kaplan–Meier analyses further showed that the estimated two-year fracture rates were significantly different between compliant and noncompliant individuals (11.9% versus 15.0%) 10. More recently, Lakatos et al reported that in 296,300 Hungarian women, both persistence and compliance were higher with parenteral and half-yearly therapies than with oral and daily/weekly/monthly therapies 11. Corroborating previous results, good compliance significantly reduced the risk of fracture (OR =0.77), fracture-related hospitalization (OR =0.72), and death (OR =0.57).…”

“…That same year, another study showed that one-third of osteoporotic women treated with oral bisphosphonates had either poor or very poor compliance 10. More recently, mean possession ratio (MPR) was found to be around 64% in almost 300,000 Hungarian individuals 11. In the same analysis, good compliance reduced the risk of fracture, fracture-related hospitalization, and death 11…”

Advances in Controlled Drug Delivery for Treatment of Osteoporosis

“…While rosuvastatin did not reduce osteoporotic risk in phase III trials, simvastatin showed promising early results by enhancing bone mechanical properties and microarchitecture via osteoblast proliferation and differentiation in preclinical trials [67]. Lovastatin and fluvastatin have also been investigated in preclinical trials [68]. …”

Geriatric falls and risk factors

“…A recent Hungarian survey found only 24% and 39% compliance for daily and weekly oral osteoporosis therapy after 12 months of treatment initiation, while compliance rate was 64% and 70% for 3-monthly and 6-monthly parenteral therapy in post-menopausal women. Good compliance was associated with a statistically significant reduction in the risk of fracture, fracture-related hospitalisation and in risk of death [78]. A former British study reported that 58.3% of the patients continued bisphosphonate treatment for more than 1 year and 23.6% for more than 5 years.…”