Alendronate Adherence and Its Impact on Hip-Fracture Risk in Patients With Established Osteoporosis in Taiwan

Abstract

A pharmacoepidemiology study was conducted using the health insurance database in Taiwan to assess compliance with osteoporosis drug regimens and the impact of compliance on the risk for secondary fractures. Patients >50 years of age with vertebral/hip fracture who had been started on alendronate therapy for the first time only after the fracture were included. Compliance was measured using the medication possession ratio (MPR) and was included as a time-dependent covariate in the Cox model to compare the difference between compliant (MPR ≥ 80%) and noncompliant patients (MPR <80%) with respect to risk for subsequent hip fractures. Only 38% of the study population remained compliant during the first year of treatment. Over the 4-year follow-up period, the risk of hip fracture among the compliant patients was 70% lower than that among the noncompliant ones (adjusted hazard ratio (HR) 0.30). Among patients with osteoporosis in Taiwan who had experienced a fracture and had started alendronate therapy, compliance with the dosage regimen was suboptimal. It was also found that compliance significantly reduced the risk of secondary hip fracture up to 4 years.

Impact of Bisphosphonate-related Osteonecrosis of the Jaw on Osteoporotic Patients after Dental Extraction: A Population-Based Cohort Study

“…Recently, the incidence of BRONJ deriving from retrospective and prospective studies was usually criticized because of the limited sample size and lack of control group. The former report about the association with ONJ and BPs use that was surveyed from medical chart review might easily be overestimated, because they might overlook the poor compliance of osteoporosis patients [21]. Moreover, identifying individual patients with ONJ from the medical records was time-consuming.…”

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

“…The included studies focussed on a wide range of disease areas including pulmonary diseases, osteoporosis, depression, cardiovascular diseases, Parkinson's disease, epilepsy, chronic kidney disease, cancer and diabetes mellitus . Two studies did not measure disease‐specific medication (non‐)adherence .…”

“…Two studies did not measure disease‐specific medication (non‐)adherence . Thirty‐six studies were specific to, or provided age stratified analysis for people aged ≥64 years, while the other 30 studies also included middle aged adults (≥50 years) . Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied.…”

“…Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied. In terms of adherence measurement, 54 studies measured medication (non‐)adherence using pharmacy claims data while 11 studies used self‐report methods, consisting of the 4‐item or 8‐item Morisky Medication Adherence Scale, or self‐reported PDC and MEMs was used in 4 studies …”

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

“…However, the results were subject to various definitions of compliance, and female gender, bisphosphonate users and different study populations were mainly focused on in each investigation [28,30]. Our data examined adherence not only among male users of oral (daily and weekly) bisphosphonates, but also among male users of calcitonin.…”