Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)

Abstract

Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions. Introduction Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication. Methods A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken. Results Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it. Conclusion These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.

Acceptability of bisphosphonates among patients, clinicians and managers: a systematic review and framework synthesis

“…47 However, interventions designed to improve bisphosphonate adherence are often designed to ‘educate’ or persuade the patient of importance and are often not targeted to eliciting or addressing health beliefs, or informed by underpinning mechanisms of change. 3 There is therefore a need to ensure that any further design of interventions—to promote bisphosphonate adherence—draws on more comprehensive theoretical models of patient engagement with health conditions and medicines such as the Extended Common Sense Model. 48 This model situates individual’s perceptions about drugs, and practical issues related to capability, in the context of illness and treatment representations.…”

“…Oral bisphosphonate persistence rates at 1 year are commonly estimated between 16% and 60%. 3 Worldwide, many people who would benefit from osteoporosis drugs are not receiving them, and this treatment gap has been described as an ‘osteoporosis crisis’. 4 The treatment gap is compounded by poor adherence which results in potentially preventable fragility fractures with their associated burden for patients and their carers, difficulties in professional–patient relationships, and wasted healthcare resources.…”

Fracture liaison service

“…The Netherlands, the number of adult people living alone is gradually increasing. Recent Dutch data show 43% of the elderly adult population to live alone (21% after divorce and 22% after death of a loved one [40].…”

“…Given the national guideline on osteoporosis and fracture prevention in the Netherlands (2011) and the excellent access to health services and the high hospital density throughout the country, the Osteoporosis Quality Indicator was introduced to monitor in all Dutch hospitals. This Quality Indicator, based on a so called Appraisal of Indicators, Research and Evaluation (AIRE) tool [39,40], meaning a hospital-self-report on the proportion of patients of 50 years and older with a recent fracture that received a DXA within 6 months post fracture. Over the last years, DXA was reported to be performed in 33% of patients on average, with a wide range (5-100%) [34,41].…”

“…Reasons for medication non-adherence and non-persistence are numerous and multidimensional and it is mandatory to understand the problem and the extent in order to identify solutions. Promising tailor-made actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen [40]. A number of methods to improve medication persistence have been reported, such as telephone-based interventions [41,42] and tailored pharmaceutical care interventions including counseling sessions with nonadherent patients [43].…”