Improving drug adherence in osteoporosis: an update on more recent studies

Abstract

Similar to other chronic diseases such as diabetes and hypertension, osteoporosis has struggled with suboptimal medication adherence, resulting in an increased risk of fractures and all-cause mortality. The goal of this narrative review was to summarize interventions to improve medication adherence in osteoporosis. Because past reviews of this topic covered published literature through 2013, we conducted our literature search to include the period between January 2012 and November 2017. We identified 10 studies evaluating healthcare system and patient interventions aimed at improving osteoporosis treatment adherence, including three fracture liaison service (FLS) programs, one pharmacist-delivered counseling program, and six patient-directed interventions consisting of three coaching or counseling programs and three interventions using reminder prompts. Four out of the six patient-directed interventions did not lead to significant improvements in outcomes, suggesting that patient-directed interventions may have limited success in this setting. The healthcare system interventions that evaluated FLS programs and pharmacist-directed tailored counseling were effective at improving medication adherence; however, the studies were not randomized, they were costly, resource intensive and effective in countries with more centralized healthcare, possibly limiting their generalizability. In conclusion, while healthcare system interventions such as FLS, and pharmacist-delivered counseling appeared to be successful in improving osteoporosis medication adherence in some settings, behavioral interventions including patient counseling and reminder prompts for medication utilization were not, perhaps due to patient perceptions regarding osteoporosis consequences and need for treatment. Thus, these patient attributes may define patients 'at high risk' for poor adherence and developing intervention approaches to enhance patient knowledge and understanding of osteoporosis and its consequences may improve the perception of the need for treatment, optimize osteoporosis care and thereby improve overall outcomes of patients with osteoporosis. We hope that the knowledge gained through our review will help inform the design of further programs aimed at optimizing osteoporosis care.

Effects of the falls and fractures clinic as an integrated multidisciplinary model of care in Australia: a pre–post study

“…Data suggest that Fracture Liaison Services, and pharmacist-delivered counselling, may have positive influences on adherence to recommended osteoporosis medications44; this is imperative, given that non-adherence to osteoporosis medications has been associated with increased fracture risk over 12 months of follow-up 45. However, the reduced 10-year fracture probability that we observed suggests that interventions other than osteoporosis medication may have a positive effect on fracture risk, particularly given the suggestion that only 4%–30% of reduced fracture risk in association with antiresorptive therapy can be attributed to changes in BMD 46.…”

Krüppel-like factor 3 inhibition by mutated lncRNAReg1cpresults in human high bone mass syndrome

“…With the progressive aging of the general population, osteoporosis has emerged as a medical and socioeconomic problem. However, most current treatment options for osteoporosis have limitations and side effects that affect their long-term administration and patient adherence ( Rachner et al, 2011 ; Jaleel et al, 2018 ). Disturbance of osteoblast or osteoclast regulation would also lead to abnormal accumulation of bone, such as osteosclerosis, which is classified according to its causative factor as either acquired or hereditary.…”

Predictors and Outcomes Associated With Adherence to Weekly Alendronate in US Military Veterans: Clinical Research Study

“…The VA’s specific guidance for osteoporosis recommends that for low adherence (<80%) to oral bisphosphonates to “institute local measures to improve adherence” after 2 years 5 ; however, reliable methods to improve adherence are lacking. 4…”

“…A review of published interventions to promote adherence to osteoporosis treatment found many interventions were not effective and the ones that reported improved adherence were expensive and/or lower quality studies. 4 With this in mind, low-adherence patients should be considered for osteoporosis therapies that are known to have better adherence, including denosumab 29 and zoledronic acid. 30 This is especially relevant for high fracture risks patients such as those with baseline fracture or tobacco users.…”