Survey Focuses on Adherence Gap in Osteoporosis Therapy


VIENNA — Most physicians remain unaware of the factors that motivate women to stay on osteoporosis therapy, according to the results of a recent survey released by the International Osteoporosis Foundation.

As a result of this physician/patient disconnect, 85% of surveyed physicians reported having patients who have discontinued bisphosphonate therapy without consulting them, and 71% still didn't know why their patients had stopped, according to the findings, which were presented at the annual European congress of rheumatology.

The goal of the survey was to shed new light on the poorly understood adherence gap in osteoporosis therapy. “Adherence gap” is a term used to describe the phenomenon whereby nearly 80% of women who take a once-daily bisphosphonate and more than half who take a once-weekly agent discontinue therapy within the first year, despite the drugs' proven ability to reduce fracture risk.

The telephone survey, conducted earlier this year in five Western European countries, involved 500 primary care physicians and rheumatologists and 502 postmenopausal women with osteoporosis. Of the women surveyed, 38% were previously on a bisphosphonate but had discontinued it; the rest were currently on a bisphosphonate.

Overall, 64% of women cited a positive motivating factor—such as the desire to do something to help themselves, or a wish to stay independent—as their primary reason for staying on bisphosphonate therapy. But only 13% of physicians said they motivated patients by explaining the benefits of bisphosphonates.

Instead, the majority of physicians indicated they emphasized the negative consequences of nonadherence. And 86% of physicians said they were unsure about how best to encourage patients to continue on therapy.

Women cited drug side effects and the inconvenience of bisphosphonate therapy, especially the need to remain upright after taking the oral medication and the necessity of fasting before and after taking the drug, as the main reasons for discontinuing treatment.

Physicians, however, most often cited a lack of understanding on the patient's part as the reason for nonadherence.

It seems the physicians have a valid point:

Of the women surveyed, 27% said they thought their fracture risk was the same regardless of whether they took their medication. An additional 17% said they didn't think their bisphosphonate had any benefit at all. Also, 51% of the women said they could not recall being advised on how long to stay on their medication.

The congress was sponsored by the European League Against Rheumatism. The International Osteoporosis Foundation survey was funded by an unrestricted educational grant from GlaxoSmithKline and Roche.

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