Studies on adherence
- General Practice Research Database: The General Practice Research Database (GPRD) is the world’s largest computerised database of anonymised longitudinal medical records from primary care that is linked with other healthcare data. Over 600 GP practices in the UK are collecting research standard data on 5 million patients. Two recent studies conducted on GPRD provide an up-to-date picture of the extent and clinical impact of non-persistence with osteoporosis treatment:
- Non-Persistence to anti-osteoporosis medications in the UK using the General Practice Research Database (GPRD): This study considered postmenopausal women who received a first prescription for an oral bisphophonate or strontium ranelate between January 1995 and March 2008. Six months after initiation of treatment more than half of women had discontinued, which increased to 68% at a year
- Fracture outcomes related to persistence and compliance with oral bisphosphonates: This study aimed to evaluate the association between persistence and compliance with bisphosphonates and fracture incidence. Only 58% of patients continued bisphosphonate treatment for over a year and 24% for longer than 5 years. Comparison of the risk of hip fracture and any osteoporotic fracture showed current users to have considerably lower risks than those whom had ceased therapy. Patients with low compliance were at higher risk of both hip and any osteoporotic fracture
- Reasons for poor adherence: Adherence to treatment is often poor in patients with chronic conditions and osteoporosis is no different. Poor adherence has been described as the ‘weakest link’ and the ‘Achilles’ Heel’ in the treatment of osteoporosis. Patients may discontinue treatment for a variety of reasons, the most common being:
- Lack of motivation: Since osteoporosis is often asymptomatic many patients experience no obvious improvement
- Adverse effects associated with some treatments
- Safety concerns about treatments (particularly common among patients taking HRT)
- Inconvenient dosing, such as daily dosing and/or the need for fasting
- Simply forgetting to take medication as directed
- Recent research conducted on postmenopausal women with osteoporosis sought to understand why patients cease to take their medications:
- 45% said they could not tolerate the side effects
- 28% stated that there was no reduction of pain
The Breaking Point Report provided a snapshot of the current situation for women with osteoporosis in the UK.
Breaking Point described the practical steps that must be taken by healthcare professionals, policy makers and commissioners, as well as the public to prevent avoidable suffering and cost of osteoporotic fractures.