Bone Abstracts

Compliance with prescribed drugs is poor in most chronic conditions and osteoporosis is no exception. Compliance integrates the concepts adherence (how much drug is taken) and persistence (for how long) and also if the patient follow the instructions for a correct use of the medication. Between 50 and 75% of patients initiating antiosteoporosis drugs are not taken the treatment 1 year later. Obviously, this problem significantly decreases the effect of drugs. A smaller increase in BMD and less reduction in fracture risk are the immediate consequences. The burden of wasting medicines that will not reach the therapeutic goals is also significant and it has been estimated that doubles the cost of one quality-adjusted year of life obtained with treatments.

The reasons for stopping medications are numerous and not well explored. Side effects is one of the most common. Fears or beliefs about the drugs, large number of concomitant medications, lack of awareness of the consequences of the osteoporosis, low priority of the disease among health problems or the debate about osteoporosis as an ‘invented disease’ are other reasons invoked. In this respect, recent reports on safety problems associated to the use of antiosteoporosis medications may be behind the decrease in the use of these drugs in the EU, in spite of the fact that the at-risk population is growing.

A number of strategies have been used in an attempt of improving adherence. Behavioural interventions, interactions between the doctor or nurse with the patient, leaflets, reminders by phone or e-mail, use of laboratory parameters or educational programs have been only partially successful in improving the current situation. Longer intervals between doses are also another widespread approach, with medications used weekly, monthly, every 6 or every 12 months. The problem then can be that one missed dose is associated with a longer period without therapeutic effect.

In summary we are still far from a fully successful strategy. In the meantime, the communication with the patient, with a detailed and clear explanation, addressing their doubts, concerns and uncertainties and explaining the treatment and their objectives is possibly the best system to mitigate the problem.