Bisphosphonates adherence for treatment of osteoporosis

Abstract

BackgroundOsteoporosis is a disease of bone metabolism in which bisphosphonates (BPS) are the most common medications used in its treatment, whose main objective is to reduce the risk of fractures. The aim of this study was to conduct a systematic review on BPs adherence for treatment of osteoporosis.MethodsSystematic review of articles on BPs adherence for treatment of osteoporosis, indexed on MEDLINE (via PubMed) databases, from inception of databases until January 2013. Search terms were “Adherence, Medication” (MeSH term), “Bisphosphonates” (MeSH term), and “Osteoporosis” (MeSH term).ResultsOf the 78 identified studies, 27 met the eligibility criteria. Identified studies covered a wide range of aspects regarding adherence and associated factors, adherence and fracture, adherence and BPs dosage. The studies are mostly observational, conducted with women over 45 years old, showing low rates of adherence to treatment. Several factors may influence adherence: socio-economic and cultural, participation of physicians when guidance is given to the patient, the use of bone turnover markers, and use of generic drugs. The monthly dosage is associated with greater adherence compared to weekly dosage.ConclusionsConsidering the methodological differences between the studies, the results converge to show that adherence to treatment of osteoporosis with BPs is still inadequate. Further experimental studies are needed to evaluate the adherence and suggest new treatment options.

Las mujeres osteoporóticas con fracturas muestran mayor cumplimiento terapéutico que las no fracturadas

“…Similar and even better results were observe with calcium and vitamin D supplements, with 74.6% of all those women affected by osteoporosis taking these supplements at the time of the interview, increasing to 84.1% in the case of patients with fractures, the difference again being statistically significant. Classically, it has been reported that patients affected by osteoporosis, in general, complied poorly with treatment, both with anti-resorptive drugs 7,8, , especially the bisphosphonates 12,13 , and with the anabolics 25 , and in a more fundamental way, with calcium and vitamin D supplements 26,27 . In some series it has been reported that the first thing that patients stop taking correctly is precisely calcium and vitamin D 28 , which is exactly the opposite to what we found in our study, where 84.1% of the fractured patients took calcium and vitamin D, while only 75.9% took any other drug.…”

“…One of these is that patients affected by osteoporosis and with fragility fractures are not indicated for treatment 5,6 . Another is that once indicated, the patients abandon treatment after a certain period of time, or do not follow the treatment correctly, which is to say that they have poor persistence or adherence [7][8][9][10][11][12][13] , which leads to an increase in the risk of fracture 14,15 . We carried out this study in a population of patients previously diagnosed with osteoporosis and monitored by their primary care doctors, with the aim of understanding some of their clinical characteristics and the possible differences in their adherence to treatment, depending on whether or not they have fragility fractures.…”

Corrigendum: A systematic review and economic evaluation of bisphosphonates for the prevention of fragility fractures

“…116,[127][128][129][130][131][132] These are summarised in Appendix 6, Table 49. The majority of these reviews reported on aledronic acid and risedronic acid.…”

“…Vieira et al 132 reviewed 27 mainly observational studies of bisphosphonates (alendronic acid, ibandronic acid, risedronic acid and zoledronic acid) covering a wide range of outcomes regarding adherence and associated factors. No data were pooled and a narrative summary of the included studies was reported.…”

“…The majority of these reviews reported on aledronic acid and risedronic acid. One review also included studies in ibandronic acid 132 and two included zoledronic acid. 130,132 The majority of reviews evaluated compliance as a MPR and persistence measured as the number of days of possession.…”