Patient-reported reasons for nonadherence to recommended osteoporosis pharmacotherapy

Abstract

Objectives As many as half of the patients recommended for osteoporosis pharmacotherapy do not take their medications. We examined patient characteristics associated with non-adherence to recommended pharmacotherapy, as well as their reasons for non-adherence in order to identify intervention targets. Methods Data come from the Patient Activation after DXA Result Notification (PAADRN) study, a randomized controlled trial of 7,749 patients 50 years old or older presenting for DXA at three health centers in the United States. We focused on the 790 patients who reported receiving a recommendation for new pharmacotherapy at baseline. Using Pearson Chi-squared tests for categorical variables, two sample t-tests for continuous variables, and multivariable multinomial logistic regression, we compared those who reported starting the recommended medication (adherers) to temporary non-adherers and non-adherers on demographics, health habits, DXA impression, FRAX risk, and osteoporosis knowledge, and examined their stated reasons for non-adherence. Results Mean age was 66.8 (SD = 8.9), 87.2% were women, and 84.2% were white. One-fourth (24.8%) reported that they did not start their recommended pharmacotherapy. In the unadjusted analyses, the only factor significantly associated with non-adherence was osteoporosis knowledge, with those having better knowledge less likely to take their medications (p < 0.05). The most common reasons for non-adherence were fear of side effects (53.3%), a dislike of taking medicine (25.3%), and the belief that the medicine would not help their condition (16.7%). Conclusion One in four patients recommended for osteoporosis pharmacotherapy declined treatment because they feared potential side effects, don’t like taking medicine, or felt that the medication would not help their condition. Improved patient counseling regarding the potential side effects of osteoporosis treatment and the risk-benefit ratio for these medications may increase adherence.

Expressed information needs of patients with osteoporosis and/or fragility fractures: a systematic review

“…In particular, our findings do not cover the use of the internet or the influence of the many and multiple media reports regarding osteoporosis and the safety of osteoporosis treatments that have emerged over recent years [ 48 ]. This is of particular importance because fear of side effects is an important deterrent to patients initiating treatment [ 49 ], and there is some evidence to suggest that these media stories are influencing clinicians as well as patients [ 50 ]. Finally, as only three included studies were focused on information giving and needs, and in some studies, little data was relevant for extraction, it is possible that there remain issues not covered by this review.…”

Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D)

“…5 Despite this, a treatment gap exists. Up to 80% of patients who experience a fragility fracture do not receive medication in the year following fracture, 6 25% of people who are offered medication decline it (non-initiation) 7 and among those who do start bisphosphonates, few persist for long enough for it to be effective, with adherence estimated at 16%–60% at 1 year. 8 Closing this treatment gap may prevent at least 20 000 hip fractures annually in the UK.…”

Quality and effectiveness of osteoporosis treatment decision aids: a systematic review and environmental scan

“…Furthermore, the number of women starting fracture prevention treatment is declining, despite the ageing population in need of treatment increasing [2]. The reasons for this decline are complex; however, the problem is not solely related to rates of identification of patients at risk: 25% of patients who are recommended bisphosphonates actively decide against starting treatment [3]. In those who do decide to start treatment, long term persistence is known to be poor [4].…”