Adherence to bisphosphonates therapy and hip fracture risk in osteoporotic women

Abstract

These results confirm that adherence to current therapeutic regimens remains suboptimal.

Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000–2007)

“…Actual treatment for osteoporosis is far from optimal, and further reductions in age-adjusted incidence can be expected. Indeed, only a small proportion of patients receive therapy after a fracture (20), and persistence and compliance with osteoporosis medications remain poor and suboptimal (21). More than one-half of the potential clinical benefits from oral bisphosphonates in patients with osteoporosis have been shown to be lost due to poor adherence with treatment (22).…”

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

“…After stopping therapy, the effect of oral bisphosphonates on fracture risk was assumed to decline linearly to zero for a period (called offset time) similar to the duration of therapy, in line with clinical studies [52,53] and previous cost-effectiveness analyses. [54] For denosumab, we suggested a declin- Relative risk of fracture during therapy (95% CI) [13,48] Adherence to therapy probabilities (%) of discontinuing therapy [49] 22.9 (6 mo), 9. probabilities (%) of poor compliance (MPR <80%) [49] [49] All non-hip fractures: 1.17 (1.09, 1.25) [50] Hip fracture: 1.35 (1.17, 1.56) [49] All non-hip fractures: 1.17 (1.09, 1.25) [50] Annual drug cost (h) [51] 414.9 Branded: 283.0 Generic: 159.8…”

Summary of AHRQ’s Comparative Effectiveness Review of Treatment to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis: Update of the 2007 Report

“…Systematic reviews conducted previously during treatment with antiresorptive drugs or among patients treated with calcium and vitamin D found that numerous additional factors were responsible for any observed risk reductions. [42][43]56 There is no evidence from RCTs to guide how often BMD should be monitored during osteoporosis therapy, and there was a "high level of evidence" from RCTs that serial BMD monitoring of the lumbar spine and femoral neck contributed little or nothing to prediction of the change in fracture risk from treatment with the antiresorptive agents, including alendronate, risedronate, raloxifene, and teriparatide. Although the data from RCTs showed that patients who lost BMD during antiresorptive therapy benefited from substantial reduction in risk of vertebral fracture, there was strong evidence that greater increases in BMD did not predict greater reduction in the risk of osteoporotic fractures.…”

“…Age, history of fracture, and number of concurrent medications do not appear to factors that influence persistence or adherence. A high strength of evidence shows that weekly dosing is associated with higher adherence than daily dosing regimens; 23,31,[34][35][36][37][38][39][40][41][42][43][44] but there is insufficient evidence that monthly regimens are associated with higher adherence compared with weekly regiments. 28,29,33,[45][46][47] Adverse effects and concerns about adverse effects are important predictors of adherence and persistence.…”