Table 1 Bisphosphonates adherence for treatment of osteoporosis: studies and main findings

Lower treatment satisfaction was associated with 22% to 67% increased risk of discontinuation/switching osteoporosis medication during 1styear of follow-up

Automatic generic substitution may have reduced persistence in participants taking alendronate. No difference was observed in persistence with proprietary risedronate during the same period.

This study failed to demonstrate that monitoring a serum bone turnover marker impact the persistence with monthly ibandronate treatment.

Treatment with Alendronate in women with postmenopausal osteoporosis reduces the urinary excretion of the bone turnover biomarker N-telopeptide (NTx). The probability of achieving a clinically significant reduction is greater in those women with higher baseline levels of NTx and in women who comply with treatment.

Before fracture, fewer rural patients had taken BPs (7.7% versus 13.3%). Following fracture, more rural then urban patients were significantly non-compliant with BPs (44% versus 52.4%). The compliance among both rural and urban patients decreased, following hip fracture.

56% of patients regarded the therapy as convenient. Patients more often accepted their disease and treatment if their physicians obtained high scores in the Social Competence Questionnaire. When physician competence regarding close emotional contact was high, only 15% of the patients revealed symptoms of fear of disease and treatment, in comparison to 40% of the patients, if the competence of the physician was low.

Using all available data (minimum 18 months, maximum 27 months), the proportion of patients with high adherence for the zoledronate and the 2 ibandronate cohorts was 62.8% versus 36.0% and 33.3%. But approximately 30% of patients taking zoledronate did not receive a second infusion.

In women, the most important factors for being adherent were advanced age and high income. In men, a middle educational level predicted adherence.

Patients receiving oral BPs on a monthly basis showed higher rates of medication compliance compared to weekly dosage in our study. However, compliance with BPs among all new patients was suboptimal (compliance- 43%)

Persistence with therapy declined from 63% at 1 year to 46% at 2 years and 12% at 9 years. Most patients experienced one or more extended gaps in BP therapy.

Persistence rates after 1 and 2 years were 27.9% and 12.9%, respectively, and 66.3% of women were compliant. After 24 months of therapy, compliant women had fewer fractures than non-compliant women. Compliance and persistence were inadequate.

There was a very good patient medication adherence of the study subjects to the 24-month treatment with BPs. MPR ranged from 0,93 to 1,0. The patient medication persistence dropped significantly at the end of month 12.

When adherence was assessed by pill count, the intervention group showed a significantly higher adherence. Overall, persistence at 1 year was high and similar between groups.

Most patients exhibited optimal medication adherence and persistence at 6 months. Analyses of adherence or persistence did not show any significant effect of the decision aid on 6-month adherence BPs.

Attendance of scheduled visits was associated with adherence to BPs.

The study suggests high adherence rates to BP therapy amongst Singaporean patients (mean MPR was 78,9% +/− 27,5% and 69% of the patients were persistent with therapy at 1 year).

Adherence to a monthly BP treatment regimen is higher than that to weekly regimens. Patients treated with a monthly regimen were 37% less likely to be non-persistent and were more compliant, with a 5% higher absolute MPR, than women treated with weekly regimens.

The study found small but significant differences in the change in hip bone mineral density between women with high compliance versus low compliance with placebo.

The once-monthly switch was associated with less adherence failure (4% fewer patients per month pre-switch vs. 1% fewer patients per month post-switch; but the impact on fracture risk was uncertain.

A significant increase of BMD in both groups and in both skeletal sites was observed at 12 months versus baseline. No difference was observed between groups. The “twice-a-month” regimen with 200 mg IM CLD may well promote an improved adherence with the same clinical efficacy and safety profile.

The fractures occurred at a rate of 43 to 1,000 people/year, showing an inverse relationship between drug adherence and fracture rate for all measures of adherence and fracture types, excluding distal forearm fractures

38% patients failed to start treatment, associated with higher BMD Z score and residence in a nursing/residential home. Persistence was associated with a lower comorbidity index and compliance with a lower BMD Z score and fall before starting treatment.

At 1 year, the proportion of persons with high BP compliance (MPR 80%) was 44%. The statin MPR variable was the most significant predictor of 1-year BP compliance, followed by age and prior receipt of BMD testing.

In the primary prevention cohort, the risk of osteoporotic fractures in the year following BP therapy initiation was reduced by 49% for compliant versus non-compliant patients. In the secondary prevention cohort, the risk of subsequent osteoporotic fracture was reduced by 57% for compliant patients versus non-compliant patients.

Patients initiated on weekly oral generic alendronate showed a statistically significant lower persistence to BP therapy compared to patients initiated on weekly oral branded risedronate and weekly oral branded alendronate.

Adherence to BP treatment by older Australian women with estabilished osteoporosis was poor; within 6 months of starting, half the women stopped their treatment. Adherence failure was more likely among smokers and women taking acid-related medication and less likely among women reporting high levels of physical activity.

Patients who switched BPs had high rates of persistence of therapy. Those who stopped their first BP because of adverse effects were at risk of discontinuing the second drug for the same reason.