Patient preference in the management of postmenopausal osteoporosis with bisphosphonates

Abstract

The leading treatments for postmenopausal osteoporosis are the nitrogen-containing bisphosphonates, which are required long term for optimal benefit. Oral bisphosphonates have proven efficacy in postmenopausal osteoporosis in clinical trials, but in practice the therapeutic benefits are often compromised by patients' low adherence. Nonadherence to bisphosphonate therapy negatively impacts outcomes such as fracture rate; fractures are in turn associated with decreased quality of life. The most common reason cited by patients for their nonadherence is that the strict dosing instructions for bisphosphonates are difficult to follow. One aspect of bisphosphonate administration that can be changed is dosing frequency and several studies have evaluated patient preferences for different dosing schedules. Studies have shown a preference for a weekly bisphosphonate regimen versus daily dosing and it has been demonstrated that this preference for reduced dosing frequency impacts on adherence. Ibandronate is the first nitrogen-containing oral bisphosphonate for osteoporosis that can be administered in a monthly regimen and two robust clinical studies demonstrated a strong patient preference for this monthly regimen versus a weekly regimen. It is important that physicians consider patient preference when prescribing treatment for osteoporosis to ensure that the disease is effectively managed for the long-term benefit of the patient.

Figure 1

Fractures are increased as a result of suboptimal adherence: trend of a 33% greater fracture rate in inconsistent^a versus consistent users (Sebaldt et al 2004). Note: ^aInconsistent = early discontinuation or self-reported taking of therapy <80% of the time over the follow-up interval.

Figure 2

Reasons given by patients for not adhering to bisphosphonate therapy for osteoporosis (IOF 2005).

Figure 3

The majority of patients expressing a preference prefer monthly bisphosphonate treatment to weekly (Emkey et al 2005; Hadji et al 2006). Note: Modified intent-to-treat populations = 298 (BALTO I), 321 (BALTO II); ^aPreference rate for monthly was significant in both studies (p<0.0001).

Figure 4

The majority of patients expressing an opinion perceived a monthly bisphosphonate regimen to be more convenient than a weekly regimen (Emkey et al 2005; Hadji et al 2006). Note: Modified intent-to-treat populations = 298 (BALTO I), 321 (BALTO II); ^aPerception that the monthly regimen was more convenient than the weekly regimen was statistically significant (p<0.0001).