Review Article

Reduced Fracture Rates Observed Only in Patients With Proper Persistence and Compliance With Bisphosphonate Therapies

Authors: Stuart L. Silverman, MD, Deborah T. Gold, PhD, Joyce A. Cramer, BS

Abstract

Numerous studies have analyzed data from administrative claims databases to determine persistence and compliance with bisphosphonate therapy for osteoporosis; several of these studies have also examined how persistence and compliance with therapy affect fracture outcomes. All of the studies included in this review demonstrated that patients who were persistent or compliant with therapy had a decreased risk of fracture. None, however, adequately addressed the question of what level of persistence or compliance is necessary to obtain a reduced risk of fracture. There is agreement among studies that compliance and persistence rates are suboptimal for all osteoporosis treatments. Measures to improve persistence and compliance with osteoporosis medications are needed if patients are to achieve the full clinical benefit of treatment.


Key Points


* Previous studies suggest that patients must take more than half the doses of their osteoporosis medication to reduce fracture risk.


* Reduced fracture rates were seen in women persisting with bisphosphonates at least 2 years, but the data available are scanty.


* Doctors and patients need more information about minimal requirements to achieve the desired effect of bisphosphonate treatment.


* It would be useful to third party payors if clarification of the benefits of poorly utilized bisphosphonates versus the costs could be delineated.

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