Medication Adherence: An Ongoing Challenge in the Management of Osteoporosis

If you are on medication for osteoporosis, are you ever tempted to stop taking it?

If your answer is yes, you are not alone. Studies indicate that especially for those with chronic conditions such as osteoporosis, many patients do not take their medication as directed or for as long as they should.

Osteoporosis is a growing problem worldwide, with the greatest burden resulting from broken bones. There are several treatment options available that are effective in reducing fracture risk, but in order to see the benefit, patient adherence is required.

Like other chronic diseases, especially those with no symptoms, adherence to osteoporosis therapies is poor. Some articles have suggested that in general, rates of non-adherence can be as high as 50%. In a recent study that looked at people on Ontario Drug Benefits, only 63% of patients given a bisphosphonate prescription were still taking it after one year, and this dropped to 46% after two years.

Why don’t people take their medications as prescribed? Possibilities include:

• Memory loss. The individual forgets when and how to take the medication.
• Lack of symptoms.  The need for and benefits of a medication are not felt. This is true of osteoporosis, which is often called “the silent thief” because there are no symptoms unless and until one has fractured.
• Side effects. The individual may experience side effects or fear the potential for immediate or longer-term side effects in the future.
• Uncertainty about the benefit of drug treatment or preference for a “natural” approach.
• Lack of understanding of the disease and the value of medication.
• Poor communication between the patient and their healthcare provider.
• Cost of medication.
• Difficulty following the instructions for use.
• Complexity of treatment, especially if the patient has multiple conditions requiring multiple drug therapies.

Consequences

Not taking your medication as prescribed has far-reaching consequences.  Poor adherence means that the drug will not be as effective and health will decline. In addition, medical costs will rise.

In 2009, it was estimated that non-adherence cost the US healthcare system $290 billion. There is little data available for Canada, but in 1995 the cost of medication non-adherence was estimated to be $7 – 9 billion annually.

Patients who do not take their prescribed medication do not receive the benefits of that medication. Patients who only partially follow their medication regime may receive some benefit but are also at risk for serious complications. Patients who do not stick with their treatment plan are more likely to end up in hospital. Studies suggest that for people taking bisphosphonate therapy for osteoporosis, those that take 75% of their medication do not have the same reduction in fracture risk as those who take the medication as prescribed 100% of the time; and when patients take only 50% (or less) of their pills, no benefit is seen (it is the same as not taking any bisphosphonate).

Over 80% of fractures in people over 50 are due to osteoporosis. There are effective medications available to reduce the risk of fracture from 30 – 70% provided they are taken properly and 100% of the time. If you are at high risk of fracture, it is very important that you take your osteoporosis medication regularly and as recommended.

Addressing your concerns

If you have concerns about treatments or medications, you should speak to your doctor – and you should ALWAYS speak with your doctor before making any changes to your medications. 

Together, you can work out how best to handle any problems. This will help ensure that you have the most appropriate therapy strategy possible for your condition and receive the greatest possible benefit from it.

Credit: COPN, the Canadian Osteoporosis Patient Network is the patient arm of Osteoporosis Canada, a national network of people living with osteoporosis.