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Many users of osteoporosis medications stop and restart treatment
Efficacy of these therapies when used with interruptions is unknown.
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A study of more than 26,000 users of osteoporosis medications has found that extended gaps in treatment are common, with many individuals returning to regular use after months or years of noncompliance.
“Suboptimal compliance with effective treatments for chronic disease is thought to be responsible for considerable morbidity and associated costs,” researchers wrote in the American Journal of Medicine. “A thorough understanding of common patterns of drug use is a necessary first step in the design of an effective intervention to improve use of prescription medications.”
To investigate this issue, M. Alan Brookhart, PhD, an instructor in medicine at Harvard Medical School in Boston, and colleagues conducted a study of compliance among users of osteoporosis medications. Previous work in the same study cohort found that 45% of patients had a period of at least 120 days in which their prescription was not refilled; the present study aimed to understand whether those patients who did discontinue their treatment ultimately resumed medication use.
26,636 patients
Of a 40,002 patients aged 65 or older who initiated a medication used for osteoporosis from 1996 to 2002; 26,636 had at least one 60-day period in which no days were covered by a prescription. These patients were predominantly women (96.3%), had an average age of 82, an average of 3.5 comorbid conditions and used an average of nine different medications. The osteoporosis medications included were bisphosphonates (11,459 patients), calcitonin (8,691 patients), estrogen therapy (4,054 patients), raloxifene (1,431 patients) and combinations of these (1,001 patients).
Approximately 30% of the study population returned to regular medication use within six months after the initial discontinuation of treatment, and 50% returned to regular use by two years. Among patients with at least six months of regular medication use at the time of the initial interruption (5,863 patients), 42% returned to regular use by six months and 59% returned by two years. Each additional 60-day period spent on the medication prior to interruption correlated with a 3% increase in the probability of returning to regular use.
Fractures and BMD tests
Patients who suffered a fracture (OR 1.30; 95% CI, 1.21-1.40) or underwent a bone density test (OR 1.26; 95% CI, 1.16-1.37) were more likely to restart therapy in the subsequent 60-day period. Nursing home stays, on the other hand, were associated with a lower likelihood of returning to treatment (OR 0.90; 95% CI, 0.82-0.98).
“The primary message is that OP medication adherence is erratic,” Brookhart told Endocrine Today. “It is not known whether these medications are effective when used in an interrupted way, so physicians should stress to their patients the need for continuous, regular use. More work is clearly needed to better understand what causes patients to discontinue treatment and also to identify things that could be done to encourage patients to re-initiate treatment.” – by Dave Levitan
For more information:
- Brookhart MA, Avorn J, Katz JN, et al. Gaps in treatment among users of osteoporosis medications: the dynamics of noncompliance. Am J Med. 2007;120:251-256.