Long-term impact of adherence to oral bisphosphonates on osteoporotic fracture incidence
Open Access
- 4 October 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in Journal of Bone and Mineral Research
- Vol. 27 (1), 202-210
- https://doi.org/10.1002/jbmr.533
Abstract
Adherence to osteoporosis treatments is a critical parameter resulting in suboptimal effectiveness in real-life practice. The long-term effect of adherence on fracture risk has not been assessed. This was a retrospective study using provincial health insurance claims databases to assess the association between adherence to oral bisphosphonates (OBP) and incidence of osteoporotic fractures in all Ontario patients with osteoporosis between April 1996 and December 2009. Multivariate logistic regression models were used to assess the association between OBP adherence and fracture risk. Treatment duration was classified into 2-year intervals. Compliance was estimated with the medication possession ratio (MPR), and persistence was defined as the length of continuous therapy without a gap in refills >30 days. The study cohort was composed of 636,114 patients, among whom 36.1% were prescribed OBPs for 0 to 2 years, 19.7% for 2 to 4 years, 15.1% for 4 to 6 years, 12% for 6 to 8 years, 9.1% for 8 to 10 years, 6.1% for 10to 12 years, and 1.9% for 12 to 14 years. Overall, the mean (SD) compliance for the cohort was 0.72 (0.30) with 53.5% of the patients having compliance >80% and 24.6% being persistent with treatment during the 14-year follow-up period. Significant associations between high adherence and reduced fracture risk over the entire 14-year period were observed; the overall odds ratio for categorical compliance (MPR >80% or MPR ≤80%), continuous compliance, and persistence were 0.909 (95% confidence interval [CI] 0.893–0.925), 0.918 (95% CI 0.893–0.944), and 0.804 (95% CI 0.787–0.821), respectively. In conclusion, adherence to OBP in osteoporosis management is suboptimal in a real-life setting. A significant positive association exists between poor adherence and increased risk of osteoporotic fractures, which becomes augmented with longer treatment duration. © 2012 American Society for Bone and Mineral ResearchKeywords
This publication has 37 references indexed in Scilit:
- Impact of Prevalent Fractures on Quality of Life: Baseline Results From the Global Longitudinal Study of Osteoporosis in WomenMayo Clinic Proceedings, 2010
- Benefit of Adherence With Bisphosphonates Depends on Age and Fracture Type: Results From an Analysis of 101,038 New Bisphosphonate UsersJournal of Bone and Mineral Research, 2008
- Impact of noncompliance with alendronate and risedronate on the incidence of nonvertebral osteoporotic fractures in elderly womenBritish Journal of Clinical Pharmacology, 2008
- Determinants of non-compliance with bisphosphonates in women with postmenopausal osteoporosisCurrent Medical Research and Opinion, 2008
- Loss of treatment benefit due to low compliance with bisphosphonate therapyOsteoporosis International, 2007
- Incidence and Economic Burden of Osteoporosis-Related Fractures in the United States, 2005–2025Journal of Bone and Mineral Research, 2007
- A claims database analysis of persistence with alendronate therapy and fracture risk in post-menopausal women with osteoporosisCurrent Medical Research and Opinion, 2007
- Persistent bisphosphonate use and the risk of osteoporotic fractures in clinical practice: a database analysis studyCurrent Medical Research and Opinion, 2006
- PERSISTENCE WITH BISPHOSPHONATE THERAPY IN OLDER PEOPLEJournal of the American Geriatrics Society, 2006
- Ten Years' Experience with Alendronate for Osteoporosis in Postmenopausal WomenThe New England Journal of Medicine, 2004