Bone Abstracts

Introduction: Bisphosphonates are the first-choice treatment for osteoporosis. However, the efficacy observed in clinical trials may not be realized in a real-life setting, partly due to poor adherence to therapy, with a significant worsening of clinical outcomes. The aim of this study conducted on an outpatient cohort is to quantify the adherence to the osteoporosis treatment in real practice setting and to identify the factors that may affect it.

Materials and methods: Two hundred and thirty-six women suffered from osteoporosis (mean age 66.4 years; S.D 9.3; range 44–88) were studied with bisphosponates (BP) between January 2004 and December 2011 were examined. We assessed the association between adherence to oral BP and incidence of osteoporotic fractures. Adherence was quantified using the medication possession ratio (MPR) per year for each patient. Adherence to treatment was defined as having MPR ≥ 80%.

Results: Adherence rates decreased from 53% for treatment lasting 0–2 years to 43% for treatment lasting 2–4 years, returning to 49% for treatment lasting more than 4 years. In the whole sample mean MPR was 60.6% Among the motivations of therapy drop-out co-morbidities, self-made decision, GI intolerance and death were the most frequent. Non-adherent patients had higher risk of fracture (adjusted odds ratio=3.4, 95% CI 1.1 to 10.5, P=0.032). Problems incompliance were reported in 85 visits (37.8%) on 51 patients (21.61%). The mean MPR per year adherence was associated with age <65 years (P=0.040), absence of co-morbidities (P=0.023), positive history of fracture (P= 0.044); having the same physician in follow-up (P= 0.025).

Conclusions: From our results it emerges the importance of the relationship between physician and patient in improving the adherence. Adherence to BP in osteoporosis management is suboptimal in a real-life setting. A significant positive association exists between poor adherence and increased risk of osteoporotic fractures which becomes augmented with longer treatment duration.