Adherence to Osteoporosis Pharmacotherapies


Lead Author(s): 

Nicole C. Wright, PhD, MPH

Low adherence to osteoporosis pharmacotherapies has been documented since bisphosphonates first became available in 1995. Less than 50% of patients starting an oral bisphosphonate are still receiving this drug one year later.1 The early formulations had strict dosing instructions and significant gastrointestinal side effects. The availability of parenteral preparations (intravenous [IV] zoledronic acid and ibandronate) and later formulations improved adherence rates, but even with these agents, adherence rates are not at 100%. Only 32% of IV zoledronic acid users received their second annual dose, and nearly 20% of IV ibandronate users received only one of the four annual doses.2  Mechanisms to improve adherence to medications include engaging pharmacists in patient education activities to encourage adherence.3,4 In Kaiser Permanente Colorado, an interactive voice response (IVR) reminder system followed by a personalized letter for patients prescribed osteoporosis medications led to increased medication purchase in the short term but did not change the medication adherence in the long term.5 Additional efforts targeting patients, providers, and the health system are needed to improve adherence to osteoporosis medications.

  • 1. Curtis JR, Westfall AO, Allison JJ, et al.: Channeling and adherence with alendronate and risedronate among chronic glucocorticoid users. Osteoporos Int 2006;17(8):1268-1274. Epub 2006 May 19.
  • 2. Curtis JR, Yun H, Matthews R, et al.: Adherence with intravenous zoledronate and intravenous ibandronate in the United States Medicare population. Arthritis Care Res (Hoboken) 2012 Jul;64(7):1054-1060. doi: 10.1002/acr.21638.
  • 3. Murphy-Menezes M: Role of the pharmacist in medication therapy management services in patients with osteoporosis. Clinical Therapeutics Jul 2015;37(7);1573-1586. Published Online: April 23, 2015. DOI: Available at: Accessed August 23, 2015.
  • 4. Stuurman-Bieze AG, Hiddink EG, van Boven JF, Vegter S.: Proactive pharmaceutical care interventions decrease patients' nonadherence to osteoporosis medication. Osteoporos Int 2014 Jun;25(6):1807-1812. doi: 10.1007/s00198-014-2659-8. Epub 2014 Feb 26.
  • 5. Cizmic AD, Heilmann RM, Milchak JL, et al.: Impact of interactive voice response technology on primary adherence to bisphosphonate therapy: A randomized controlled trial. Osteoporos Int 2015 Aug;26(8):2131-2136. doi: 10.1007/s00198-015-3116-z. Epub 2015 May 9.


  • 2014

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