Adoption of Once-monthly Oral Bisphosphonates and the Impact on Adherence



      The extent of the adoption of once-monthly bisphosphonates into general clinical practice is not known, nor is it known if the novel formulation improves adherence.


      We analyzed administrative claims 2003-2006 from a large employer-based health insurance database for incident use of oral bisphosphonates and stratified users by daily, weekly, and monthly dosing regimen. We measured adherence as the medication possession ratio (MPR) during the first year of therapy. We compared patient characteristics by dosing regimen and evaluated how the dosing regimen influenced the MPR.


      We identified 61,125 incident users of bisphosphonates (n=1034 daily, n=56,925 weekly, n=3166 monthly). Monthly bisphosphonate users were, on average, slightly older than the other groups (mean age 66 years for monthly users vs 65 years for weekly users or 66 years for daily users, P<.05) and more often lived in the North Central or South United States (76% vs 72% weekly users or 69% daily users, P<.05). There were no detectable differences among the dosing groups in the history of serious gastrointestinal risk, comorbidity burden, or prior osteoporotic fractures. During the first year of bisphosphonate therapy, 49% of monthly users had MPR80% compared with 49% of weekly users (not significant) or 23% of daily users (P<.0001).


      We found little evidence of preferential prescribing of monthly bisphosphonates to certain types of patients. Furthermore, we found no evidence of improved bisphosphonate adherence with monthly dosing relative to weekly dosing, although adherence with either weekly or monthly dosing was significantly better than with daily dosing.


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        • Chesnut I.C.
        • Skag A.
        • Christiansen C.
        • et al.
        Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis.
        J Bone Miner Res. 2004; 19: 1241-1249
        • Delmas P.D.
        • Recker R.R.
        • Chesnut 3rd, C.H.
        • et al.
        Daily and intermittent oral ibandronate normalize bone turnover and provide significant reduction in vertebral fracture risk: results from the BONE study.
        Osteoporos Int. 2004; 15: 792-798
      1. Boniva Product Labeling.
        (vol v3.13)March 2005
        • Miller P.D.
        • McClung M.R.
        • Macovei L.
        • et al.
        Monthly oral ibandronate therapy in postmenopausal osteoporosis: 1-year results from the MOBILE study.
        J Bone Miner Res. 2005; 20: 1315-1322
        • Recker R.R.
        • Gallagher R.
        • MacCosbe P.E.
        Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women.
        Mayo Clin Proc. 2005; 80: 856-861
        • Cramer J.A.
        • Silverman S.
        Persistence with bisphosphonate treatment for osteoporosis: finding the root of the problem.
        Am J Med. 2006; 119: S12-S17
        • Cramer J.A.
        • Amonkar M.M.
        • Hebborn A.
        • Altman R.
        Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis.
        Curr Med Res Opin. 2005; 21: 1453-1460
        • Solomon D.H.
        • Avorn J.
        • Katz J.N.
        • et al.
        Compliance with osteoporosis medications.
        Arch Intern Med. 2005; 165: 2414-2419
        • Kripalani S.
        • Yao X.
        • Haynes R.B.
        Interventions to enhance medication adherence in chronic medical conditions: a systematic review.
        Arch Intern Med. 2007; 167: 540-550
        • Gold D.T.
        • Safi W.
        • Trinh H.
        Patient preference and adherence: comparative US studies between two bisphosphonates, weekly risedronate and monthly ibandronate.
        Curr Med Res Opin. 2006; 22: 2383-2391
        • Emkey R.
        • Koltun W.
        • Beusterien K.
        • et al.
        Patient preference for once-monthly ibandronate versus once-weekly alendronate in a randomized, open-label, cross-over trial: the Boniva Alendronate Trial in Osteoporosis (BALTO).
        Curr Med Res Opin. 2005; 21: 1895-1903
        • Adamson D.M.
        • Chang S.
        • Hansen L.G.
        Health Research Data for the Real World: The MarketScan Databases.
        Thomson Medstat, Ann Arbor, MI2005
      2. MarketScan Research Databases User Guide and Database Dictionary.
        Thomson Medstat, Ann Arbor, MI2006
        • Andrade S.E.
        • Gurwitz J.H.
        • Chan K.A.
        • et al.
        Validation of diagnoses of peptic ulcers and bleeding from administrative databases: a multi-health maintenance organization study.
        J Clin Epidemiol. 2002; 55: 310-313
        • Ash A.S.
        • Ellis R.P.
        • Pope G.C.
        • et al.
        Using diagnoses to describe populations and predict costs.
        Health Care Financ Rev. 2000; 21: 7-28
        • Zhao Y.
        • Ellis R.P.
        • Ash A.S.
        • et al.
        Measuring population health risks using inpatient diagnoses and outpatient pharmacy data.
        Health Serv Res. 2001; 36: 180-193
        • Cooper A.
        • Drake J.
        • Brankin E.
        Treatment persistence with once-monthly ibandronate and patient support vs once-weekly alendronate: results from the PERSIST study.
        Int J Clin Pract. 2006; 60: 896-905
        • Weiss T.W.
        • Henderson S.C.
        • McHorney C.A.
        • Cramer J.A.
        Persistence across weekly and monthly bisphosphonates: analysis of US retail pharmacy prescription refills.
        Curr Med Res Opin. 2007; 23: 2193-2203
        • Simon J.
        • Beusterien K.
        • Kline Leidy N.
        • Hebborn A.
        Women with postmenopausl osteoporosis express a preference for once-monthly ibandronate versus once-weekly bisphosphonate treatment.
        Female Patient. 2005; 30: 31-36
        • Briesacher B.A.
        • Andrade S.E.
        • Yood R.A.
        • Kahler K.H.
        Consequences of poor compliance with bisphosphonates.
        Bone. 2007; 41 (Epub 2007 Jul 18): 882-887
        • Yood R.A.
        • Emani S.
        • Reed J.I.
        • et al.
        Compliance with pharmacologic therapy for osteoporosis.
        Osteoporos Int. 2003; 14: 965-968
        • Tosteson A.N.
        • Grove M.R.
        • Hammond C.S.
        • et al.
        Early discontinuation of treatment for osteoporosis.
        Am J Med. 2003; 115: 209-216