Persistence to medical treatment of osteoporosis in women at three different clinical settings

Abstract

Purpose: This study was undertaken to assess persistence with bisphosphonates and raloxifene and to identify determinants of adherence (patient age, level of information, educational status, etc.) among women with osteoporosis in three different clinical settings in Denmark. Methods: We compared persistence to therapy in three historical cohorts of women diagnosed with osteoporosis starting therapy between January 1999 and January 2004. The study comprised 878 patients treated and followed at Odense University Hospital, 285 patients diagnosed and followed at the Hellerup Osteoporosis Clinic (private practice), and 343 patients diagnosed at Aarhus University Hospital and followed by the referring general practitioner. Data on persistence and possible confounders were collected using a mailed questionnaire. Reminders were issued after 1—2 months to non-respondents. Results: Persistence at 2 years as estimated from Kaplan—Meyer analysis was 0.87, 0.84 and 0.88 in the three cohorts, respectively. There were no significant differences between the clinics. Level of persistence was not related to patient assessment of the adequacy of the clinical information provided by the prescribing doctor, presence of prior fractures or a family history of osteoporosis. However, patients who read the information leaflet on their osteoporosis medication tended to be more persistent with treatment (p < 0.09). Conclusions: Women’s persistence with bisphosphonates and raloxifene was surprisingly high and similar between treating centres. This may be due to a high level of public information available on osteoporosis in Denmark.

Keywords

Information medical treatment osteoporosis persistence women’s health

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References

Cramer JA , Gold DT , Silverman SL , Lewiecki EM A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 2007; 18(8):1023-31.

Solomon DH , Avorn J. , Katz JN , Finkelstein JS , Arnold M. , Polinski JM , et al. Compliance with osteoporosis medications . Arch Intern Med 2005;165(20):2414-19.

Wulff R. , Abrahamsen B. , Ejersted CA , Christensen PM , Brixen KT [Compliance with the treatment of osteoporosis with diphosphonates. A questionnaire among postmenopausal women, in Danish]. Ugeskr Laeger 2004;166(1-2): 49-53.

Kothawala P. , Badamgarav E. , Ryu S. , Miller RM , Halbert RJ Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis . Mayo Clin Proc 2007; 82(12):1493-501.

Silverman SL , Gold DT , Cramer JA Reduced fracture rates observed only in patients with proper persistence and compliance with bisphosphonate therapies. South Med J 2007;100(12):1214-18.

Caro JJ , Ishak KJ , Huybrechts KF , Raggio G. , Naujoks C. The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 2004;15(12):1003-8.

Huybrechts KF , Ishak KJ , Caro JJ Assessment of compliance with osteoporosis treatment and its consequences in a managed care population . Bone 2006;38(6):922-8.

Mosekilde L. , Beck-Nielsen H. , Sorensen OH , Nielsen SP , Charles P. , Vestergaard P. , et al. Hormonal replacement therapy reduces forearm fracture incidence in recent postmenopausal women results of the Danish Osteoporosis Prevention Study. Maturitas 2000 ;36(3):181-93.

Komulainen MH , Kroger H. , Tuppurainen MT , Heikkinen AM , Alhava E. , Honkanen R. , et al. HRT and Vit D in prevention of non-vertebral fractures in postmenopausal women; a 5 year randomized trial. Maturitas 1998 ;31(1):45-54.

10.

Ettinger B. , Black DM , Mitlak BH , Knickerbocker RK , Nickelsen T. , Genant HK , et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999;282(7):637-45.

11.

Black DM , Cummings SR , Karpf DB , Cauley JA , Thompson DE , Nevitt MC , et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996;348(9041):1535-41.

12.

Reginster J. , Minne HW , Sorensen OH , Hooper M. , Roux C. , Brandi ML , et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group . Osteoporos Int 2000;11(1):83-91.

13.

Neer RM , Arnaud CD , Zanchetta JR , Prince R. , Gaich GA , Reginster JY , et al. Effect of parathyroid hormone (134) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344(19):1434-41.

14.

Roux C. , Fechtenbaum J. , Kolta S. , Isaia G. , Andia JB , Devogelaer JP Strontium ranelate reduces the risk of vertebral fracture in young postmenopausal women with severe osteoporosis. Ann Rheum Dis 2008;67(12):1736-8.

15.

Chapuy MC , Arlot ME , Delmas PD , Meunier PJ Effect of calcium and cholecalciferol treatment for three years on hip fractures in elderly women. BMJ 1994;308(6936):1081-2.

16.

Dawson-Hughes B. , Harris SS , Krall EA , Dallal GE Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337(10):670-6.

17.

Dowd R. , Recker RR , Heaney RP Study subjects and ordinary patients. Osteoporos Int 2000;11(6):533-6.

18.

Siris ES , Harris ST , Rosen CJ , Barr CE , Arvesen JN , Abbott TA , et al. Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases. Mayo Clin Proc 2006;81(8):1013-22.

19.

McCombs JS , Thiebaud P. , Laughlin-Miley C. , Shi J. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 2004;48(3):271-87.

20.

Osterberg L. , Blaschke T. Adherence to medication. N Engl J Med 2005;353(5):487-97.

21.

Rossini M. , Bianchi G. , Di MO , Giannini S. , Minisola S. , Sinigaglia L. , et al. Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 2006; 17(6):914-21.

22.

Fraenkel L. , Gulanski B. , Wittink D. Patient treatment preferences for osteoporosis . Arthritis Rheum 2006;55(5):729-35.

23.

Simon JA , Lewiecki EM , Smith ME , Petruschke RA , Wang L. , Palmisano JJ Patient preference for once-weekly alendronate 70 mg versus once-daily alendronate 10 mg: a multicenter, randomized, open-label, crossover study . Clin Ther 2002;24(11):1871-86.

24.

Pickney CS , Arnason JA Correlation between patient recall of bone densitometry results and subsequent treatment adherence. Osteoporos Int 2005;16(9):1156-60.

25.

Clowes JA , Peel NF , Eastell R. The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 2004; 89(3):1117-23.

26.

Cook PF , Emiliozzi S. , McCabe MM Telephone counseling to improve osteoporosis treatment adherence: an effectiveness study in community practice settings. Am J Med Qual 2007;22(6):445-56.

27.

Ross CE , Wu CL Education, age, and the cumulative advantage in health. J Health Soc Behav 1996;37(1):104-20.

28.

Varenna M. , Binelli L. , Zucchi F. , Ghiringhelli D. , Gallazzi M. , Sinigaglia L. Prevalence of osteoporosis by educational level in a cohort of postmenopausal women. Osteoporos Int 1999;9(3):236-41.

29.

Cortet B. , Benichou O.

Adherence, persistence, concordance: do we provide optimal management to our patients with osteoporosis?

Joint Bone Spine 2006;73(5):e1-7.

Persistence to medical treatment of osteoporosis in women at three different clinical settings - A historical cohort study

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