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Osteoporos Int. 2019 Aug 7. doi: 10.1007/s00198-019-05104-5. [Epub ahead of print]

Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF).

Author information

1
Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. m.hiligsmann@maastrichtuniversity.nl.
2
Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
3
Research and Development, AARDEX Group and Department of Public Health, University of Liège, Liege, Belgium.
4
Open Patient Data Explorative Network, Institute of Clinical Resesarch, University of Southern Denmark, Odense, Denmark.
5
Department of Medicine, Holbæk Hospital, Holbæk, Denmark.
6
NDORMS, University of Oxford, Oxford, UK.
7
Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
8
Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
9
FirmoLab, Fondazione FIRMO e Università di Firenze, Florence, Italy.
10
Division of Public Health, Epidemiology and Health Economics, Liège, Belgium and WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liege, Belgium.
11
Global Head of Patient Insights Innovation, Patient Solution Unit, Sanofi, Lyon, France.
12
MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.
13
NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
14
Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France.
15
Musculoskeletal Research Unit, IMIM-Parc Salut Mar, CIBERFES, Universitat Autònoma de Barcelona, Barcelona, Spain.
16
Department of Public Health, University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania.
17
Patient partner, Geneva, Switzerland.
18
Frankfurt Centre of Bone Health, Frankfurt, Germany & Philips-University of Marburg, Marburg, Germany.
19
International Osteoporosis Foundation, Nyon, Switzerland.
20
Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
21
Mary McKillop Health Institute, Catholic University of Australia, Melbourne, Australia.
22
Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.
23
Scientific Office, Austrian Federal Office for Safety in Health Care, Vienna, Austria.
24
CNR Aging Branch-NI, Padua, Italy.
25
Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne and INSERM U1059, Université de Lyon-Université Jean Monnet, Saint-Etienne, France.
26
Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, İstanbul University Cerrahpaşa, Istanbul, Turkey.
27
Medical Faculty, Department of Pharmacology, Medical University Sofia, Sofia, Bulgaria.

Abstract

Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions.

INTRODUCTION:

Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication.

METHODS:

A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken.

RESULTS:

Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it.

CONCLUSION:

These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.

KEYWORDS:

Adherence; Determinants; Osteoporosis; Persistence; Solutions

PMID:
31388696
DOI:
10.1007/s00198-019-05104-5

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