Osteoporosis treatment persistence poor in Sweden
MedWire News: Persistence to osteoporosis treatment in Sweden is poor, with approximately half of all patients discontinuing therapy during the first year, researchers report.
Yet, nearly all patients who persist with treatment appear to take their medication according to treatment instructions, as demonstrated by a high medicine possession ratio, say Oskar Ström (Karolinska Institutet, Stockholm) and colleagues.
"The primary aim of pharmaceutical therapy is to reduce the risk of osteoporotic fractures," write the researchers in the journal Osteoporosis International.
"However, patients need to take the medication for the intended duration (persistence) and according to treatment instructions (compliance) in order to receive the desired clinical benefit," they add.
To investigate persistence and compliance to osteoporosis treatment and its association with fractures, Ström and team extracted data from the Swedish Prescribed Drug Register.
They identified 56,586 treatment-naïve patients (mean age 71 years, 86% women) who began osteoporosis treatment between 2005 and 2009. Of these, 23% terminated treatment immediately after the duration of the index prescription.
The proportion of patients who persisted with treatment after 1, 2, 3, and 4 years was 51%, 35%, 25%, and 14%, respectively.
In contrast to the low rates of persistence, the researchers found that compliance while on treatment was high, at 94.2%, and just over one third of patients (38.0%) were fully compliant, with no gaps between prescriptions.
Using the Swedish national patient register, the team identified 2980 fractures among the patients. Treatment persistence was significantly inversely associated with 3-year incidence of hospitalized fractures.
Specifically, patients with 1-2 years, and 2-3 years of treatment had significant 33% and 41% reductions in fracture risk, respectively, relative to patients who persisted with treatment for less than one month. Patients who persisted for 1-12 months had a non-significant 14% reduction in fracture risk.
"This study has shown that persistence to treatment of primary osteoporosis in Sweden is poor, not in line with treatment guidelines, and should be recognized as a serious problem in the medical management of osteoporotic patients," Ström and co-authors remark.
They conclude by calling for action to improve the current situation.
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By Laura Dean