Adherence: The Full Story

WHAT IS ‘ADHERENCE’?

The term ‘adherence’ is used to describe how people take their treatment. It refers to a combination of taking treatment correctly (compliance) and continuing to take medication for the recommended amount of time (persistence on therapy).

ADHERENCE IN OSTEOPOROSIS

As is the case with other long-term conditions, many people with osteoporosis find it hard to take their treatment over a long period of time.

After 6 months, more than a fifth of people with osteoporosis stop taking their treatment¹
After one year, approximately half of people with osteoporosis taking daily and weekly treatments are likely to still stay on therapy^1,2,3
After two years, over two thirds of patients on a daily treatment are likely to have stopped taking their therapy⁴

WHY PEOPLE WITH OSTEOPOROSIS DON’T CONTINUE ON TREATMENT

In 2005, IOF launched an investigation into the disturbing lack of adherence to osteoporosis treatment. Their findings were published in a report – The Adherence Gap: Why Osteoporosis Patients Don’t Continue With Treatment: available here (PDF 1.0 MB).

The report summarised the results of a survey among 500 physicians and 502 women with osteoporosis, conducted across five European countries (France, Germany, Italy, Spain and the UK). The research sought to understand why so many women are struggling to adhere to their treatment, and potential ways in which this problem can be addressed.

The majority of women questioned said they had experienced difficulties in taking their treatment - yet, 70% of physicians acknowledged they did not know why so many women stop taking their treatment⁵
Although 90% of women viewed osteoporosis as a serious condition, over two thirds were not aware of the benefits of their treatment, in some cases, wrongly believing that there were no benefits at all⁵
The majority of physicians acknowledged they wanted their patients to remain on treatment long-term. However, just over half of patients could not recall being told how long treatment would last⁵

WHAT IS THE IMPACT OF THIS WIDESPREAD LACK OF ADHERENCE TO TREATMENT?

The fact that so many people stop their treatment has a significant impact on the individual. However, it also imposes a serious financial and social burden from wasted medication and escalating treatment costs, to an increased need for carers and lack of working hours.

In Europe alone, osteoporosis now costs more than €4.8 billion a year in hospital healthcare⁶ - unless the fracture rate is reduced, these costs are likely to increase still further
Psychologically, suffering an osteoporosis-related fracture may cause a fear of falling and general lack of confidence in mobility. This can lead to social isolation, depression and an increased dependency on family and friends⁷
In women over 45, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes, heart attack and breast cancer⁸

CLOSING THE ADHERENCE GAP

As the ageing population continues to grow, the number of people suffering from osteoporosis will also increase. Encouraging and helping people to stay on treatment must become a priority for everyone dedicated to tackling the implications of this widespread disease. Although reducing how often treatments need to be taken and acknowledging patients’ opinions and preferences when developing a treatment plan have improved the situation⁹, there are still not enough people staying on treatment. As a result, IOF will work with its member patient groups to explore ways of tackling the adherence problem and developing practical solutions that can be implemented in a real-life setting.

However, in the meantime, if you agree staying on treatment is a problem in osteoporosis, and/ or would like more information on how to improve adherence and reduce the burden of fractures, please click here.*

* Please note, the number of people who click here to request more information will be recorded and this number may be shared with third parties such as the media, patient groups and healthcare professionals to prompt people to address the adherence problem.

References

Reginster JY and Rabenda V. Adherence to anti-osteoporotic treatment: Does it really matter? Future Rheumatol. 2006; 1 (1): 37-40
Cramer J, Amonkar MM, Hebborn A and Suppapanya N. Does dosing regimen impact persistence with bisphosphonate therapy among postmenopausal osteoporotic women? Journal Bone Mineral Research 2004; 19 Suppl 1: S448
Ettinger MP, Gallagher R, Amonkar M, Smith JC, and MacCosbe PE. Medication persistence is improved with less frequent dosing of bisphosphonates, but remains inadequate. Arthritis Rheum. 2004; 50 Suppl 1: S513
Fardellone P, Gaudin AF, Cotte FE, Lafuma A, Marchand C and El Hasnaoui A. Comparison of the persistence of daily and weekly bisphosphonates in French female patients treated for osteoporosis. Abstract presented at the 27th Annual Meeting of the American Society for Bone and Mineral Research; 2005 September 23-27; Nashville, Tennessee. (Abstract SU416)
IPSOS Health. European Survey of Physicians and Women with Osteoporosis. January – April 2005. Sponsored by Roche/ GSK
Lips P; International Osteoporosis Foundation (IOF) Committee of Scientific Advisors. Invest in your bones: quality of life. Why prevent the first fracture? International Osteoporosis Foundation (IOF). Nyon (Switzerland): 2003
Department of Health. National Service Framework for Older People. Modern Standards and Service Models. London (UK): 2001
Kanis JA, Delmas P, Burckhardt P, Cooper C and Torgerson D; The European Foundation for Osteoporosis and Bone Disease. Guidelines for diagnosis and management of osteoporosis. Osteoporosis International 1997; 7: 390-406
Unson CG, Siccion E, Gaztambide J, Gaztambide S, Mahoney Trella P and Prestwood K. Non-adherence and osteoporosis treatment preferences of older women: a qualitative study. Journal of Women’s Health 2003; 12 (10): 1037-45