Persistence with osteoporosis medication among newly-treated osteoporotic patients

Abstract

Low persistence with osteoporosis medication is associated with higher fracture risk. Previous studies estimated that 1-year persistence with osteoporosis medication is low. Our aim was to study persistence with osteoporosis medication among patients with long-term follow-up (to 5 years). The InterAction Database (IADB) was used to analyze persistence of 8610 Dutch patients initiating osteoporosis drugs between 2003 and 2011. Drugs under study were alendronate, risedronate, ibandronate, etidronate, raloxifene and strontium ranelate. Cumulative persistence rates were calculated after different time frames (3 months-5 years) using survival analysis. Multivariate Cox proportional hazard analyses were used to identify determinants of non-persistence. Furthermore, switching rates of persistent patients who initiated bisphosphonate therapy were analyzed. Persistence with osteoporosis therapy was 70.7 % (95 % CI, 69.7-71.7), 58.5 % (95 % CI, 57.4-59.6 %), 25.3 % (95 % CI, 24.1-26.5) after 6 months, 1 and 5 years, respectively. Determinants associated with higher risk to non-persistence within the first year were daily dosing regimen [HR, 1.76 (95 % CI, 1.46-2.14)], age <60 years [HR, 1.26 (95 % CI, 1.19-1.34)] and use of glucocorticoids [HR, 1.16 (95 % CI, 1.07-1.26)]. Monthly dosing schedule and use of generic brands of alendronate did not show a significant association with non-persistence. Approximately 4.0 % of patients initiating therapy with weekly alendronate or weekly risedronate switched therapy. Persistence with osteoporosis medication is low. Because low persistence is strongly associated with higher fracture risk, interventions to improve persistence are recommended. This study identified several patient groups in whom such interventions may be most relevant.

How the knowledge of fracture risk might influence adherence to oral therapy of osteoporosis in Italy: the ADEOST study

“…As expected, in elderly osteoporotic patients we have observed that aging is associated with a worsening of compliance and persistence; nevertheless, several studies have reported a lower adherence in osteoporotic patients aged less than 60 years [30] or 50 years [31]. Moreover, in agreement with previous studies the presence of comorbidities was associated with reduced adherence with fracture prevention medications [16].…”

Long-term persistence with anti-osteoporosis drugs after fracture

“…They also found increased persistence among patients allowed to switch medications (58 % [95 % CI 45–70 %) vs 46 % [95 % CI 38–55 %]). Another study that was conducted among new users irrespectively of fracture status and that similarly defined persistence as the present study (90-day gap and allowed switching between drugs) found a 1-year persistence estimate of 67 % (95 % CI 66–68), which was still lower as compared to the current study [15]. This suggests that the setting, where treatment was initiated after a recent fracture, may have influenced persistence.…”

Factors associated with high 24-month persistence with denosumab: results of a real-world, non-interventional study of women with postmenopausal osteoporosis in Germany, Austria, Greece, and Belgium

“…Several studies have shown that younger age, specifically individuals less than 60 years old versus older age, is associated with lower persistence and adherence [13, 16, 18, 19]. While one study found no association between age and persistence [14], others have reported older age to be associated with lower persistence [17].…”