Determinants of adherence to osteoporosis treatment in clinical practice

Rossini, Maurizio; Bianchi, Gerolamo; Munno, Ombretta Di; Giannini, Sandro; Minisola, Salvatore; Sinigaglia, Luigi; Adami, Silvano

doi:10.1007/s00198-006-0073-6

Cited by 251 publications

(149 citation statements)

References 25 publications

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“…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.…”

Section: Discussioncontrasting

confidence: 99%

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

Henríquez

Canario²

2014

Rev Osteoporos Metab Miner

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SummaryBackground: Fractures are a clinical complication of osteoporosis. Sufficient therapeutic compliance is necessary to reduce the risk of fracture. The literature suggests that a significant percentage of patients with osteoporosis soon abandon treatment, both drugs and calcium and vitamin D supplements. Objectives: To study the degree of compliance with osteoporosis therapy in a population of women affected by the disease, with and without fragility fractures. Patients and method: 413 women with a diagnosis of osteoporosis already established were included in the study consecutively, as they attended a health centre, without any selection or recruitment campaign. Results: 38.6% of the women had suffered at least one fragility fracture, the most frequent being non-vertebral fractures as a whole, followed by vertebral fractures. Fractured patients had an average age 5 years older than those without fractures. The overall proportion of patients who were taking regular treatment was 66.1%, with the proportion of compliant patients being higher in those who had a fragility fracture, at 75.9% for those taking drugs in general and 84.1% for those taking calcium and vitamin D supplements, as against 59.7% and 68.4% respectively for those without fracture (p<0.001). Conclusions: Those women affected by fragility fractures were older and had a greater adherence to treatment, both for drugs in general and for calcium and vitamin D supplements, than patients with osteoporosis without fractures. Non-vertebral fractures were those most commonly observed fractures.

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Section: Discussioncontrasting

confidence: 99%

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

Henríquez

Canario²

2014

Rev Osteoporos Metab Miner

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“…This may appear shocking at first sight because in all the therapeutic guides and recommendations of professional organisations for the treatment of osteoporosis it is widely known and recommended that an adequate supply of calcium and vitamin D is the basis, and should always be associated with, treatment with osteoactive drugs for osteoporosis 48 . The high prevalence of women with vitamin D insufficiency, despite being subject to treatment, could be an indication of a potential absence of compliance 49 . Another possibility may be that the genetic makeup of our patients conditions for lower levels of vitamin D 50 .…”

Section: Impact On Bonementioning

confidence: 99%

Deficiencia de vitamina D en España: ¿realidad o mito?

Valverde

Gómez

2014

Rev Osteoporos Metab Miner

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Vitamin D 3 (colecalciferol) is formed from its precursor 7-dehydrocholesterol in the skin by ultraviolet irradiation. In the liver the vitamin D 3 is hydroxylated to form 25-hydroxyvitamin D 3 , which is metabolised to its active metabolite 1,25-dihydroxyvitamin D 3 preferentially in the kidney. Vitamin D 3 may also be provided in the diet, which is a significant source of supply only in the case of insufficient exposure to sunlight. Blue fish naturally contains large quantities of vitamin D 3 , while other foods contain significant quantities of vitamin D only after being fortified. For fortification, in many countries vitamin D 2 is used (ergocalciferol) obtained from vegetable sources 1 . The presence of the enzyme CYP27B1, which drives the synthesis of dihydroxyvitamin D from its principal substrate, 25-hydroxyvitamin D, and the vitamin D receptor (VDR), distributed almost universally in the cells and tissues of the organism, confers on vitamin D (although it would be increasingly more correct to say the endocrine system of vitamin D) a broad role in health. This is not only in the regulation of calcium and bone metabolism but also in relation to the cardiovascular system, innate or acquired immunomodulation, the regulation of cell growth, etc., such that around 3% of the human genome is regulated by the hormone 1,25(OH) 2 vitamin D 3 1-3 . It is therefore not surprising that basic scientific and clinical interest in vitamin D 4 , as well as interest in the non-specialist press and in the general population 5 , has increased almost exponentially in the last decade. 25-hydroxyvitamin D, marker for the status of vitamin D in the bodyFor some years there has been universal consensus that the measurement of the levels of the metabolite 25-hydroxyvitamin D in the blood is the marker for the status of vitamin D in the body, including the endogenous synthesis due to exposure to sunlight, dietary consumption in foods, supplemented or not, and pharmacological treatments 1,2

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“…[10] Determinants of poor adherence include inconvenient regimens, adverse effects and lack of motivation. [11,12] Denosumab represents a new therapeutic opportunity for the treatment of osteoporosis. The FREEDOM (Fracture REduction Evaluation of Denosumab in Osteoporosis every six Months) trial has recently shown subcutaneous administration of 60 mg of denosumab every 6 months to be well tolerated, to increase bone mineral density (BMD) and to significantly reduce the risks of vertebral, non-vertebral and hip fractures in women with osteoporosis over 3 years.…”

Section: Introductionmentioning

confidence: 99%

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

Hiligsmann

Reginster

2011

PharmacoEconomics

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Background: Denosumab has recently been shown to be well tolerated, to increase bone mineral density (BMD) and to significantly reduce the risk of hip, vertebral and non-vertebral fractures in the FREEDOM (Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months) trial. It is becoming increasingly important to evaluate not only the therapeutic value of a new drug but also the cost effectiveness compared with the most relevant treatment alternatives. Objective: The objective of this study was to estimate the cost effectiveness of denosumab compared with oral bisphosphonates (branded and generic drugs) in the treatment of post-menopausal osteoporotic women in Belgium. Methods: Cost effectiveness of 3 years of treatment with denosumab was compared with branded risedronate and branded and generic alendronate using an updated version of a previously validated Markov microsimulation model. The model was populated with relevant cost, adherence and epidemiological data for Belgium from a payer perspective and the results were presented as costs per QALY gained (h, year 2009 values). Analyses were performed in populations (aged ‡60 years) in which osteoporosis medications are currently reimbursed in many European countries, i.e. those with BMD T-score of -2.5 or less or prevalent vertebral fracture. Patients receiving denosumab were assumed to have a 46% lower risk of discontinuation than those receiving oral bisphosphonates, and the effect of denosumab after treatment cessation was assumed to decline linearly to zero over a maximum of 1 year. Results: Denosumab was cost effective compared with all other therapies, assuming a willingness to pay of h40 000 per QALY gained. In particular, denosumab was found to be cost effective compared with branded alendronate and risedronate at a threshold value of h30 000 per QALY and denosumab was dominant (i.e. lower cost and greater effectiveness) compared with risedronate from the age of 70 years in women with a T-score of -2.5 or less and no prior fractures. The cost effectiveness of denosumab compared

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Determinants of adherence to osteoporosis treatment in clinical practice

Cited by 251 publications

References 25 publications

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

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

Deficiencia de vitamina D en España: ¿realidad o mito?

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

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