Adherence to treatment of osteoporosis: a need for study

Lekkerkerker, Frits J.F.; Kanis, John А.; Alsayed, Nouf; Bouvenot, G; Burlet, Nansa; Cahall, David; Chines, Arkadi; Delmas, Pierre D.; Dreiser, R.-L.; Ethgen, D; Hughes, Nicola; Kaufman, Jean‐Marc; Korte, Sven; Kreutz, Gottfried; Laslop, Andrea; Mitlak, Bruce; Rabenda, Véronique; Rizzoli, René; Santora, A.; Schimmer, Ralph C.; Tsouderos, Y; Viethel, P.; Reginster, Jean‐Yves

doi:10.1007/s00198-007-0410-4

Cited by 101 publications

(71 citation statements)

References 39 publications

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“…[55] This assumption is rather conservative since recent data have shown that the treatment benefit achieved (changes in BMD) with 2 years of denosumab therapy was reversed within 2 years of treatment discontinuation. [56] Adherence Adherence to osteoporosis medications is a major concern [57] and may substantially affect costeffectiveness results. [58,59] For modelling purposes, adherence was divided into 'compliance' (i.e.…”

Section: Cost Effectiveness Of Denosumab For Post-menopausal Osteopormentioning

confidence: 99%

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

Hiligsmann

Reginster

2011

PharmacoEconomics

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Background: Denosumab has recently been shown to be well tolerated, to increase bone mineral density (BMD) and to significantly reduce the risk of hip, vertebral and non-vertebral fractures in the FREEDOM (Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months) trial. It is becoming increasingly important to evaluate not only the therapeutic value of a new drug but also the cost effectiveness compared with the most relevant treatment alternatives. Objective: The objective of this study was to estimate the cost effectiveness of denosumab compared with oral bisphosphonates (branded and generic drugs) in the treatment of post-menopausal osteoporotic women in Belgium. Methods: Cost effectiveness of 3 years of treatment with denosumab was compared with branded risedronate and branded and generic alendronate using an updated version of a previously validated Markov microsimulation model. The model was populated with relevant cost, adherence and epidemiological data for Belgium from a payer perspective and the results were presented as costs per QALY gained (h, year 2009 values). Analyses were performed in populations (aged ‡60 years) in which osteoporosis medications are currently reimbursed in many European countries, i.e. those with BMD T-score of -2.5 or less or prevalent vertebral fracture. Patients receiving denosumab were assumed to have a 46% lower risk of discontinuation than those receiving oral bisphosphonates, and the effect of denosumab after treatment cessation was assumed to decline linearly to zero over a maximum of 1 year. Results: Denosumab was cost effective compared with all other therapies, assuming a willingness to pay of h40 000 per QALY gained. In particular, denosumab was found to be cost effective compared with branded alendronate and risedronate at a threshold value of h30 000 per QALY and denosumab was dominant (i.e. lower cost and greater effectiveness) compared with risedronate from the age of 70 years in women with a T-score of -2.5 or less and no prior fractures. The cost effectiveness of denosumab compared

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Section: Cost Effectiveness Of Denosumab For Post-menopausal Osteopormentioning

confidence: 99%

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

Hiligsmann

Reginster

2011

PharmacoEconomics

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“…One of these is that patients affected by osteoporosis and with fragility fractures are not indicated for treatment 5,6 . Another is that once indicated, the patients abandon treatment after a certain period of time, or do not follow the treatment correctly, which is to say that they have poor persistence or adherence [7][8][9][10][11][12][13] , which leads to an increase in the risk of fracture 14,15 . We carried out this study in a population of patients previously diagnosed with osteoporosis and monitored by their primary care doctors, with the aim of understanding some of their clinical characteristics and the possible differences in their adherence to treatment, depending on whether or not they have fragility fractures.…”

Section: Introductionmentioning

confidence: 99%

Las mujeres osteoporóticas con fracturas muestran mayor cumplimiento terapéutico que las no fracturadas

Henríquez

Canario²

2014

Rev Osteoporos Metab Miner

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SummaryBackground: Fractures are a clinical complication of osteoporosis. Sufficient therapeutic compliance is necessary to reduce the risk of fracture. The literature suggests that a significant percentage of patients with osteoporosis soon abandon treatment, both drugs and calcium and vitamin D supplements. Objectives: To study the degree of compliance with osteoporosis therapy in a population of women affected by the disease, with and without fragility fractures. Patients and method: 413 women with a diagnosis of osteoporosis already established were included in the study consecutively, as they attended a health centre, without any selection or recruitment campaign. Results: 38.6% of the women had suffered at least one fragility fracture, the most frequent being non-vertebral fractures as a whole, followed by vertebral fractures. Fractured patients had an average age 5 years older than those without fractures. The overall proportion of patients who were taking regular treatment was 66.1%, with the proportion of compliant patients being higher in those who had a fragility fracture, at 75.9% for those taking drugs in general and 84.1% for those taking calcium and vitamin D supplements, as against 59.7% and 68.4% respectively for those without fracture (p<0.001). Conclusions: Those women affected by fragility fractures were older and had a greater adherence to treatment, both for drugs in general and for calcium and vitamin D supplements, than patients with osteoporosis without fractures. Non-vertebral fractures were those most commonly observed fractures.

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“…(8,9) We have previously reported that RIS arrested the tissue aging encountered in untreated osteoporosis, (13) although it should be kept in mind that the study in that report was a clinical trial, thus potentially not representative of the ''real'' world due to likely compliance differences. (30)(31)(32)(33) In addition, differences have been seen in effects on intrinsic bone material properties in animal studies. In a comparative study in normal dogs, 1 year with ALN significantly reduced the work-to-failure/areal BMD relationship in the vertebra compared to placebo, but in animals treated with RIS the relationship was not different from placebo.…”

Section: Discussionmentioning

confidence: 99%

Effects of alendronate and risedronate on bone material properties in actively forming trabecular bone surfaces

Hofstetter

Gamsjaeger

Phipps³

et al. 2012

Journal of Bone and Mineral Research

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We used Raman and Fourier transform infrared microspectroscopy (FTIRM) analysis to examine the intrinsic bone material properties at actively bone-forming trabecular surfaces in iliac crest biopsies from women with postmenopausal osteoporosis (PMO) who were treated with either alendronate (ALN) or risedronate (RIS). At eight study sites, women were identified who had postmenopausal osteoporosis (PMO), were at least 5 years postmenopause, and had been on long-term therapy (either 3-5 years or >5 years) with daily or weekly ALN or RIS. Following standard tetracycline labeling, biopsies were collected from 102 women (33 treated with ALN for 3-5 years , 35 with ALN for >5 years , 26 with RIS for 3-5 years , and 8 with RIS for >5 years ) and were analyzed at anatomical areas of similar tissue age in bone-forming areas (within the fluorescent double labels). The following outcomes were monitored and reported: mineral to matrix ratio (corresponding to ash weight), relative proteoglycan content (regulating mineralization commencement), mineral maturity (indicative of the mineral crystallite chemistry and stoichiometry, and having a direct bearing on crystallite shape and size), and the ratio of two of the major enzymatic collagen cross-links (pyridinoline/divalent). In RIS-5 there was a significant decrease in the relative proteoglycan content (À5.83% compared to ALN-5), while in both RIS-3 and RIS-5 there was significantly lower mineral maturity/ crystallinity (À6.78% and À13.68% versus ALN-3 and ALN-5, respectively), and pyridinoline/divalent collagen cross-link ratio (À23.09% and À41.85% versus ALN-3 and ALN-5, respectively). The results of the present study indicate that ALN and RIS exert differential effects on the intrinsic bone material properties at actively bone-forming trabecular surfaces. ß

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Adherence to treatment of osteoporosis: a need for study

Cited by 101 publications

References 39 publications

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

Cost Effectiveness of Denosumab Compared with Oral Bisphosphonates in the Treatment of Post-Menopausal Osteoporotic Women in Belgium

Las mujeres osteoporóticas con fracturas muestran mayor cumplimiento terapéutico que las no fracturadas

Effects of alendronate and risedronate on bone material properties in actively forming trabecular bone surfaces

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