Staying Power: Closing The Adherence Gap In Osteoporosis
Staying Power: Closing The Adherence Gap In Osteoporosis, developed in May 2006, provides a summary of the international evidence available on the impact of non-adherence.* By highlighting the social, financial and personal implications that arise when so many people fail to adhere to treatment in the long-term, the report raises awareness of the real cost of this crucial issue and reprioritise lack of adherence so it is given the attention it deserves.
Download the Staying Power Report (3.83 MB, 27 pages)
* Adherence is defined as patients taking treatment correctly (compliance) and continuing to take treatment for the recommended amount of time (persistence on therapy)
Professor Jean-Yves Reginster
Professor of Epidemiology, Public Health and Health Economics, University of Liege, Belgium and IOF General Secretary
Not so long ago, campaigners had to fight to convince the medical community that osteoporosis deserved recognition as an important and widespread disease. Today, although understanding of the disease itself has increased, the successful management of osteoporosis is still under threat from another aspect of under-recognition.
Like many chronic diseases, the effective management of postmenopausal osteoporosis is restricted by the difficulties patients often experience in taking their medication over a long period of time. A ‘silent disease’, osteoporosis is also frequently under-diagnosed, meaning people often end up sustaining a fracture before their condition is recognised. Just identifying those in the earlier stages of osteoporosis and initiating treatment can be a challenge in itself. However, even if people are diagnosed and commence treatment, with almost half stopping their medication after only one year, all this initial effort goes to waste. Without regular treatment, patients are putting themselves at increased risk of fracture, which, in the worst cases, can lead to long-term hospitalisation or death.
It is not enough to simply recognise that adherence is an issue. Steps must be taken to arm physicians, patients, family members and carers with the information they need to help people stay on treatment. If we are to ensure that fracture rates - and the associated personal and social costs - do not increase still further, we need to be sure these patients are not overlooked. Otherwise, we may be neglecting the welfare of millions of people around the world.
Staying Power: Closing The Adherence Gap In Osteoporosis
Executive Summary
Osteoporosis: The Adherence Challenge
Osteoporosis is a serious and widespread disease, affecting one in three women and one in five men over fifty.1,2,3 Although treatment to reduce the risk of fracture is available, many patients are struggling to stay on their treatment for a beneficial length of time:
By the end of their first year of treatment, up to half of people with osteoporosis will have stopped taking their medication.4,5
The Implications of Lack of Adherence
Personal Burden
- After experiencing a vertebral fracture, less than one third of patients will regain their previous level of mobility and over a third will require constant care6
- Suffering an initial fracture increases the chances of experiencing another: people who have suffered three or more fractures are 10 times more likely to experience another break7
- Fractures and their associated complications can be fatal and approximately 25-30% of patients who suffer a hip fracture die within a year8
Social Burden
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In women over 45, osteoporosis accounts for more days spent in hospital than many other diseases, including diabetes, heart attack and breast cancer9
- People who have suffered a fracture may be less able to undertake paid employment and have to rely on friends and relatives to provide care and assistance with everyday activities
Economic Burden
In Europe, the annual direct costs of treating osteoporosis amount to €13.7 billion (US$17billion)10
By 2050, the worldwide cost burden of osteoporosis is set to increase to €106 billion ($131.5 billion)11
Closing the Adherence Gap
As the ageing population continues to grow, so too will the prevalence of osteoporosis. Therefore, addressing lack of adherence must become a priority, with all those involved in the management of osteoporosis working together to help people stay on their treatment.
- It has been demonstrated that acknowledging patient preference can improve adherence:12 physicians can help empower patients by seeking their input during treatment decisions
- Research shows that patients are encouraged to stay on therapy by positive motivation:13 physicians can involve patients by explaining the benefits of treatment during consultation
- It has been shown that adherence is inversely related to frequency of dosing:14 physicians can consider dosing frequency and patient preference when discussing treatment options
- Patient support groups, family and friends can also encourage people to continue taking their osteoporosis treatment
References
1. Melton LJ, Chrischilles EA, Cooper C, Lane AW and Riggs BL. Perspective. How many women have osteoporosis? Journal of Bone and Mineral Research 1992; 7 (9): 1005-10
2. Melton LJ, Atkinson EJ, O'Connor MK, O'Fallon WM and Riggs BL. Bone density and fracture risk in men. Journal of Bone Mineral Research 1998; 13 (12): 1915-23
3. Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporosis International 2000; 11 (8): 669-74
4. Cramer J, Amonkar MM, Hebborn A and Suppapanya N. Does dosing regimen impact persistence with bisphosphonate therapy among postmenopausal osteoporotic women? Journal of Bone Mineral Research 2004; 19 Suppl 1: S448
5. 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
6. Milne HW; International Osteoporosis Foundation (IOF) Committee of Scientific Advisors. Invest in your bones: make it or break it. How exercise helps to build and maintain strong bones, prevent falls and fractures, and speed rehabilitation. Osteoporosis Australia and International Osteoporosis Foundation. Sydney (Australia): 2005
7. Nevitt MC, Ross PD, Palermo L, Musliner T, Genant K and Thompson DE; Fracture intervention trial research group. Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: Effect of number and spinal location of fractures. Bone 1999; 25 (5): 613-619
8. Schrager S. Osteoporosis prevention in primary care. Wisconsin Medical Journal 2003; 102 (3): 52-56
9. 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
10. World Health Organisation Collaborating Centre; International Osteoporosis Foundation (IOF) Committee of Scientific Advisors. Invest in your bones. Osteoporosis in the workplace: the social, economic and human costs of osteoporosis on employees, employers and governments. Liege (Belgium): 2002
11. Johnell O. The socioeconomic burden of fractures: today and in the 21st century. American Journal of Medicine 1997; 103(2A): 20S-25S
12. 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
13. IPSOS Health. European Survey of Physicians and Women with Osteoporosis. January – April 2005. Sponsored by Roche/ GSK
14. Reginster JY and Rabenda V. Adherence to anti-osteoporotic treatment: Does it really matter? Future Rheumatol. 2006; 1 (1): 37-40
