Comparison of raloxifene and bisphosphonates based on adherence and treatment satisfaction in postmenopausal Asian women

Abstract

We evaluated adherence with raloxifene therapy compared with daily bisphosphonate in Asian postmenopausal women at increased risk of osteoporotic fractures. In this 12-month observational study conducted in Asia (Hong Kong, Malaysia, Pakistan, Philippines, Singapore, Taiwan), 984 postmenopausal women (aged 55 years or older) were treated with raloxifene 60 mg/day (n = 707; 72%) or daily bisphosphonate (alendronate 10 mg/day; n = 206; 21%, or risedronate 5 mg/day; n = 71; 7%) during their normal course of care. Patients were assessed at baseline, 6, and 12 months. Baseline characteristics (including age, race, education, menopausal status, and baseline fractures) were comparable between the raloxifene and bisphosphonate groups. More women on raloxifene completed the study compared with those on bisphosphonate (50.2% versus 37.5%; P < 0.001). Patients also took raloxifene for a longer period than bisphosphonate (median, 356 versus 348 days; P = 0.011). Compared with those taking bisphosphonate, significantly fewer patients taking raloxifene discontinued the study because of stopping treatment (5.7% versus 10.1%, P = 0.017) or changing treatment (2.8% versus 9.7%, P < 0.001). Inconvenient dosing was reported as a primary reason for discontinuation due to stopping or changing treatment in 19 (6.9%) bisphosphonate patients compared with 0 raloxifene patients. The percentage of patients who had consumed 80% or more of their study medication was similar for raloxifene patients (48-56 weeks; 95.2%) and bisphosphonate patients (48-56 weeks; 93.3%). More raloxifene patients responded that they were satisfied with their medication than bisphosphonate patients at 48-56 weeks (P = 0.002). We concluded that Asian postmenopausal women at increased risk of osteoporotic fractures showed a greater propensity to remain on raloxifene compared with bisphosphonate. The women on raloxifene exhibited lower discontinuation rates and higher treatment satisfaction.

Osteonecrosis of the jaw induced by oral administration of bisphosphonates in Asian population: five cases

“…It is well known that this drug is effective irrespective of race [27][28][29][30][31][32][33]. Therefore, we can predict that the side effects from bisphosphonate are also independent of race.…”

Adherence to osteoporosis medications amongst Singaporean patients

“…An observational study comparing raloxifene and bisphosphonates based on adherence and treatment satisfaction in postmenopausal Asian women concluded that osteoporotic women taking raloxifene exhibited lower discontinuation rates and higher treatment satisfaction compared to bisphosphonates [20]. However, this study had several limitations, including the fact that the data were collected through a questionnaire administered to patients.…”

Current and Emerging Pharmacologic Therapies for the Management of Postmenopausal Osteoporosis

“…57,91 In a study 57 of postmenopausal Asian women, the 12-month completion rate for daily treatment with either alendronate or risedronate was significantly lower than that with raloxifene (37.5% vs. 50.2%, p < 0.001). Results of a Spanish study 91 that evaluated daily therapy with raloxifene or alendronate over a 1-year period also showed significantly higher compliance rates in patients receiving raloxifene vs. alendronate (68.7% vs. 54.0%, p < 0.001).…”

“…In both studies, women taking raloxifene reported greater satisfaction with treatment compared with those taking bisphosphonates ( p < 0.01). 57,91 Discontinuation rates for women taking hormone therapy appear to be generally similar to or greater than that for women taking bisphosphonates or raloxifene. 89 Poor persistence with treatment may be associated with smaller decreases in bone turnover, smaller increases in BMD, and a higher risk of fracture and disability.…”

“…Evidence indicates that inconvenient dosing is a primary reason for lack of compliance and patient dissatisfaction with oral bisphosphonates. 56,57 Intravenous bisphosphonates, including ibandronate and zoledronic acid, have been approved more recently as a treatment alternative for postmenopausal osteoporosis. Although their increased potency allows for more prolonged suppression of bone turnover and longer dosing intervals, intravenous bisphosphonates are generally more expensive than the oral formulations and are sometimes associated with transient flu-like symptoms (acute-phase reactions) and selflimited myalgia.…”