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. 2008 Apr;19(4):511-7.
doi: 10.1007/s00198-007-0466-1. Epub 2007 Sep 14.

Loss of treatment benefit due to low compliance with bisphosphonate therapy

F J A Penning-van Beest  1 , J A Erkens, M Olson, R M C Herings
Affiliations

Loss of treatment benefit due to low compliance with bisphosphonate therapy

F J A Penning-van Beest et al. Osteoporos Int. 2008 Apr.

Abstract

Among 8,822 new female bisphosphonate users, non-compliant bisphosphonate use was associated with a 45% increased risk of osteoporotic fracture compared to compliant use (MPR >or=80%). Classifying compliance into five categories, fracture risk gradually increased with poorer compliance. These results emphasize the importance of treatment compliance in obtaining maximal treatment benefit.

Introduction: Bisphosphonates are widely used to treat osteoporosis and reduce fracture risk. Low compliance is frequent and will limit treatment benefit.

Methods: New female users of alendronate or risedronate between 1999-2004, aged >or=45 years were identified from PHARMO-RLS, including drug-dispensing and hospitalization data of >or= 2 million residents of the Netherlands. Patients were followed until first hospitalisation for an osteoporotic fracture, death, or end of study period. Compliance with bisphosphonates during follow-up was measured over 90-day intervals using Medication Possession Ratio (MPR). The association between compliance and fracture risk was analyzed using time-dependent Cox-regression.

Results: The study cohort included 8,822 new female bisphosphonate users, contributing in total 22,484 person-years of follow-up. During follow-up, 176 osteoporotic fractures occurred (excluding the first six months). Non-compliant bisphosphonate use was associated with a 45% increased fracture risk compared to compliant use (MPR >or= 80%). Classifying compliance into five categories, fracture risk gradually increased with poorer compliance (p-value <0.05 for trend). A MPR <20% was associated with an 80% increased fracture risk compared to a MPR >or= 90%.

Conclusions: These results show a statistically significant association between level of compliance with bisphosphonates and level of fracture risk, emphasizing the importance of treatment compliance in obtaining maximal treatment benefit.

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Figures

Fig. 1
Fig. 1
Compliance with bisphosphonates, classified in five MPR categories, after six months, one year, two years and three years of follow-up. MPR: medication possession ratio
Fig. 2
Fig. 2
The relationship between compliance with bisphosphonates, classified in five MPR categories, and fracture risk more than half a year after starting treatment. HRs are adjusted for age and history of fracture and are compared to a MPR ≥90%. MPR: medication possession ratio, HR: hazard ratio, CI: confidence interval
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