The Pharmaceutical Journal
Vol 277 No 7429 p660
2 December 2006

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Most women quickly stop taking bisphosphonates

POEM series

Clinical question Do women continue osteoporosis therapy for a meaningful period?

Bottom line Approximately half the women initially prescribed a bisphosphonate — daily or weekly treatment — will not be taking it after three months, and only one in five will be taking it after a year. Since this short duration is unlikely to provide them with meaningful benefit, the money spent on bone mineral density testing and the rest of the diagnostic work-up and follow-up, along with the cost of the initial drug therapy, is essentially wasted on four out of five women diagnosed with osteoporosis.

Synopsis The authors of this analysis evaluated a large managed care drug database to determine the use patterns of patients who were prescribed drugs for osteoporosis. They evaluated adherence (the percentage of doses taken) and persistence (the use of continuous therapy) in 10,566 women. The women (average age 64 years) were newly diagnosed with osteoporosis and had been started on a bisphosphonate and probably calcium/vitamin D, although these were not tracked in the database. All women were continuously eligible for medical benefits coverage over the 18 months of the study. Eighty-five per cent of the women were placed on a weekly dosing regimen. Women quickly stopped taking the drug therapy, with only approximately 50 per cent of the women taking it after three months, and only one in five still taking the drug after one year. Accordingly, the women missed approximately 40 per cent of the doses they should have taken over the course of a year. Weekly users were slightly more adherent than daily users, although the results are still poor (63 per cent versus 54 per cent; P<0.05). Persistence and adherence did not vary among the three bisphosphonates. These results are similar to those seen in other studies.

Level of evidence 1b (individual randomised controlled trial with narrow confidence interval)

Reference Downey TW, Foltz SH, Boccuzzi SJ, Omar MA, Kahler KH. Adherence and persistence associated with the pharmacologic treatment of osteoporosis in a managed care setting. Southern Medical Journal 2006;99:570-5.

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