Adherence to osteoporosis regimens among men and analysis of risk factors of poor compliance: a 2-year analytical review

Abstract

BackgroundTo investigate adherence and patient-specific factors associated with poor compliance with osteoporosis regimens among men.MethodsIn this retrospective chart review study, we collected data on male patients with osteoporosis treated in accordance with therapeutic recommendations. Adherence was determined by the compliance and persistence of those patients who had been dispensed an osteoporosis regimen after an index prescription. All osteoporosis regimens were considered equivalent for the purpose of investigating adherence.ResultsThe prescriptions of 333 males met the inclusion criteria for data collection. The mean age was 68.6 ± 10.4 years. The median medication possession ratio (MPR, %) at years 1 and 2 was 90.1% (interquartile range (IQR) 19–100) and 53.7% (IQR 10.4-100), respectively; 52.3% of male patients at year 1 and 37.5% at year 2 had good compliance (defined as a MPR≧80%). The 1- and 2-year persistence rates were 45.9% and 30.0%, respectively. Patient-specific factors associated with poor compliance (MPR < 80%) during year 1 were first prescriptions given by orthopedists (odds ratio (OR) = 2.67; 95% confidence interval (CI) = 1.58-4.53; adjusted OR = 2.30, 95% CI = 1.26-4.22, p = 0.007). Male patients with rheumatoid arthritis (RA) (OR = 0.22, 95% CI = 0.06-0.78, adjusted OR = 0.19, 95% CI = 0.04-0.81, p = 0.025) and baseline bone mineral density (BMD) measurements (OR = 0.52, 95% CI = 0.32-0.85; adjusted OR = 0.51; 95% CI = 0.28-0.93, p = 0.029) were less likely to have poor compliance.ConclusionsAdherence to osteoporosis regimens in males was suboptimal in our study. Poor compliance was more likely in prescription of the first anti-osteoporotic regimen by an orthopedist. Men with RA and BMD measurements before therapy had a lower risk of non-adherence. Healthcare professionals need to target patients with specific factors to improve adherence to osteoporotic regimens.

Adherence to alendronic or risedronic acid treatment, combined or not to calcium and vitamin D, and related determinants in Italian patients with osteoporosis

“… 9 Finally, but no less important, feedback to the patient on laboratory tests and bone densitometry results, his or her physical and psychological state, his or her socioeconomic situation, comorbidities, and polytherapy are likely to be determinants of adherence. 4 – 7 , 10 , 23 According to literature, this study showed that factors potentially associated with high adherence were: older age (>50 years), female sex, and some concomitant therapies (corticosteroids for systemic use, gastrointestinal diseases drugs). However, neurological and cardiovascular drugs and polytherapy continually reduced adherence throughout the follow-up ( P <0.001).…”

“…7 , 9 , 21 , 22 However, these regimens also do not ensure optimal effectiveness, as many observational studies have already reported. 6 , 23 Insufficient calcium intake and lack of vitamin D are the most common causes of nonresponse to antiosteoporosis therapy. 13 In particular, incidence of hypovitaminosis D in Italy is extremely high, especially among the elderly.…”

Persistence with denosumab and persistence with oral bisphosphonates for the treatment of postmenopausal osteoporosis: a retrospective, observational study, and a meta-analysis

“…In the majority of studies, a patient was defined as non-persistent with treatment if the time period between two consecutive prescription fills exceeded the length of the permissible gap. The most commonly used permissible gap was 30 days [ 5 , 30 , 32 – 40 , 44 , 49 , 52 , 55 , 56 , 58 , 61 , 65 ]; other commonly used permissible gaps were 60 and 90 days. In nine studies [ 6 , 31 , 40 – 42 , 45 , 47 , 64 , 66 ], patients were allowed to accumulate medicine (i.e., use supply from a previous prescription) and in 16 studies [ 6 , 30 – 32 , 34 , 39 , 40 , 44 – 46 , 52 , 54 , 55 , 57 , 61 , 63 ], they were allowed to switch between treatments during the study period (e.g., from alendronate to risedronate or from weekly to daily oral BPs).…”

“…Of the 40 included studies, 39 reported at least one estimate of 12-month persistence with treatment (Fig. 4 ) [ 6 , 30 – 67 ] and 17 [ 5 , 6 , 31 , 32 , 37 , 45 , 46 , 48 , 50 – 52 , 55 , 58 , 59 , 61 , 64 , 65 ] reported at least one estimate of 24-month persistence (Table 3 ). Estimates of 12-month persistence varied widely, from 10 to 78 %, with the majority of estimates ranging from 30 to 60 %, and there was a large amount of heterogeneity between studies in the methods used (Fig.…”

Association between teriparatide treatment persistence and adherence, and fracture incidence in Taiwan: analysis using the National Health Insurance Research Database

“…However, adherence to antiosteoporotic drugs, in general, is low in Taiwan. Low rates of adherence have been reported for alendronate (38.2 % patients with MPR ≥80 % at 12 months) in Taiwan using the NHIRD [ 32 ], and to bisphosphonates and calcitonin (37.5 % patients with MPR ≥80 % at 24 months) [ 33 ]. In a retrospective analysis of NHIRD data from 32,604 patients initiating bisphosphonate therapy in Taiwan, nearly 50 % of patients were found to be nonadherent (MPR < 80 %) to bisphosphonates at 3 months, and approximately 70 % were nonadherent at 1 year [ 34 ].…”