The American Journal of Medicine
Volume 122, Issue 2, Supplement , Pages S3-S13, February 2009

Impact of Osteoporosis Treatment Adherence on Fracture Rates in North America and Europe

  • Ethel S. Siris, MD

      Affiliations

    • Toni Stabile Osteoporosis Center and the Metabolic Bone Diseases Program, Department of Medicine, Columbia University Medical Center, New York, New York, USA
    • Corresponding Author InformationRequests for reprints should be addressed to Ethel S. Siris, MD, Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, New York, New York 10032
    • ,
  • Peter L. Selby, MD

      Affiliations

    • Department of Medicine, Manchester Royal Infirmary, Manchester, England, United Kingdom
    • ,
  • Kenneth G. Saag, MD

      Affiliations

    • Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
    • ,
  • Fredrik Borgström, PhD

      Affiliations

    • Medical Management Center, Karolinska Institute, Stockholm, Sweden
    • i3 Innovus, Stockholm, Sweden
    • ,
  • Ron M.C. Herings, PhD

      Affiliations

    • PHARMO Institute, Utrecht, Netherlands
    • ,
  • Stuart L. Silverman, MD

      Affiliations

    • David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA

Abstract 

Fragility fractures associated with osteoporosis constitute a significant public health concern. Clinical trials have shown that a variety of agents—bisphosphonates, raloxifene, calcitonin, hormone replacement therapy, teriparatide, and strontium ranelate—can reduce the risk of osteoporosis-related fragility fractures. However, low levels of compliance and persistence in the real-life setting mean that efficacy benefits observed in clinical trials with these agents may not translate into equivalent effectiveness in daily practice. The aim of this review is to provide a comprehensive evaluation of compliance and persistence data from retrospective/observational studies, with particular reference to studies that consider the effects on fracture rates. PubMed of the National Center for Biotechnology Information (NCBI) and Web of Science databases were searched for publications detailing observational or retrospective analyses of adherence, compliance, and persistence with osteoporosis therapies. In addition, authors provided relevant studies that were not retrieved using the search criteria. In total, 17 unique publications were identified. Analysis of the publications indicated that low compliance and persistence rates for osteoporosis therapies in the real-life setting result in increased rates of fragility fractures. The results emphasize the importance of good treatment compliance and persistence with osteoporosis therapies in order to achieve a significant therapeutic benefit and thereby reduce the burden that osteoporosis and associated fractures place on individuals and healthcare systems.

Keywords: Adherence, Compliance, Fracture, Osteoporosis, Persistence

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 Statement of author disclosure: Please see the Author Disclosures section at the end of this article.

PII: S0002-9343(08)01190-X

doi:10.1016/j.amjmed.2008.12.002

The American Journal of Medicine
Volume 122, Issue 2, Supplement , Pages S3-S13, February 2009

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