High treatment compliance, low persistence among osteoporosis patients
MedWire News: Compliance with osteoporosis treatment is high among patients who are already taking medication, but persistence is low among patients starting treatment for the first time, study findings indicate.
Furthermore, the majority of non-persistent patients do not restart or switch to other treatment regimens once they have stopped the initial treatment, report J Coen Netelenbos (VU University Medical Center, Amsterdam, The Netherlands) and colleagues.
To study the compliance and persistence for all available oral osteoporosis medications in The Netherlands over a 12-month period, the researchers analyzed data from a prescription database that represents 73% of all pharmacies in the country.
They defined compliance as a medication possession ratio (MPR) of 80% or above, and persistence as continued refilling of prescriptions for more than 6 months.
Among 105,506 patients who received at least three prescriptions, the 12-month compliance rate was 91%.
The researchers remark that the high compliance rate may, in part, be due to the exclusion of patients with less than three prescriptions. It may also be because the cost of osteoporosis medication is reimbursed in The Netherlands, they add.
There were 8626 patients who started therapy during the study period. Of these, 43% persisted with treatment for more than 6 months.
During a further follow-up of 18 months in non-persistent patients, the researchers found that 22.3% restarted therapy, of whom 85.0% restarted the original drug and 15.0% switched to another oral osteoporosis medication.
Multivariate analysis revealed that persistence increased with increasing age, was higher among patients in medium- or low-density urban areas versus high urbanization, and among patients using calcium and/or vitamin D supplementation versus non-users.
In contrast, persistence was lower among users of glucocorticoids or cardiovascular medication versus non-users.
Writing in the journal Osteoporosis International, Netelenbos and co-authors conclude that the low level of persistence observed indicates "a major failure to adequately treat patients at high risk for fractures in daily practice."
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By Laura Dean