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Bisphosphonates in the management of postmenopausal osteoporosis--optimizing efficacy in clinical practice.

Bock O, Felsenberg D - Clin Interv Aging (2008)

Bottom Line: However, treatment effects in an individual patient and cost-effectiveness in public health perspective are vitally dependent on the long-term patient adherence as well as on compliance and persistence.Treatment acceptance could be further improved by IV bisphosphonates with their benefit of only quarterly, or even once-yearly, application.In addition, to ensure best possible patient adherence and maximum treatment benefits, physicians should consider individual patient conditions affecting compliance and persistence as well as patient preferences.

View Article: PubMed Central - PubMed

Affiliation: Center for Muscle and Bone Research, Campus Benjamin Franklin, Charité - University Medicine Berlin, Berlin, Germany. oliver.bock@charite.de

ABSTRACT
Nitrogen-containing bisphosphonates are potent inhibitors of osteoclastic bone resorption. With their individually proven efficacy to significantly reduce the incidence of vertebral and/or non-vertebral fractures and with their overall beneficial safety profile, alendronate, ibandronate, risedronate, and zoledronate are considered today a treatment of first choice in postmenopausal osteoporosis. However, treatment effects in an individual patient and cost-effectiveness in public health perspective are vitally dependent on the long-term patient adherence as well as on compliance and persistence. As compliance and persistence with daily oral bisphosphonates are shown to be suboptimal in many patients, leading to an increased fracture incidence in non-compliant patients, there is a need to improve overall adherence for bisphosphonate treatment in order to achieve maximum treatment effects. One option is to extend dosing intervals to weekly (alendronate, risedronate) or monthly (ibandronate) oral regimens. Less frequent oral regimens are generally preferred by majority of patients. Another alternative is intravenous, instead of oral application (ibandronate, zoledronate). Treatment acceptance could be further improved by IV bisphosphonates with their benefit of only quarterly, or even once-yearly, application. Treatment decisions should be based on anti-fracture efficacy data first. In addition, to ensure best possible patient adherence and maximum treatment benefits, physicians should consider individual patient conditions affecting compliance and persistence as well as patient preferences.

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Related in: MedlinePlus

Persistence refers to the duration of time during which a medication is taken. Compliance is the proportion of medication taken at a given time according to instructions while persistent. Adherence represents compliance over time and can be estimated within discrete periods using the medication possession ratio. Reproduced with permission from Badamgarav E, Fitzpatrick LA. 2006. A new look at osteoporosis outcomes: the influence of treatment, compliance, persistence, and adherence. Mayo Clin Proc, 81:1009–12. Copyright © 2006 Mayo Foundation for Medical Education and Research. All rights reserved.
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fig4: Persistence refers to the duration of time during which a medication is taken. Compliance is the proportion of medication taken at a given time according to instructions while persistent. Adherence represents compliance over time and can be estimated within discrete periods using the medication possession ratio. Reproduced with permission from Badamgarav E, Fitzpatrick LA. 2006. A new look at osteoporosis outcomes: the influence of treatment, compliance, persistence, and adherence. Mayo Clin Proc, 81:1009–12. Copyright © 2006 Mayo Foundation for Medical Education and Research. All rights reserved.

Mentions: Compliance describes the quality of intake of a given medication and considers the extent to which a dosing regimen and its associated instructions are followed. Compliance can often be quantified by a surrogate measure, the medication-possession ratio (MPR), which is the number of days of available medication divided by the number of days of study follow-up. Persistence describes the length of time patients continue to take their medication, and is defined as the time from treatment initiation to treatment completion/discontinuation. Adherence is a summary term that is determined by compliance and persistence of medication intake and describes the extent and the quality of medication intake (see Figures 3 and 4) (Badamgarav and Fitzpatrick 2006; Payer et al 2007). Adherence to medication in postmenopausal osteoporosis is in line with the general finding of low persistence rates in other chronic diseases (Reginster and Rabenda 2006).


Bisphosphonates in the management of postmenopausal osteoporosis--optimizing efficacy in clinical practice.

Bock O, Felsenberg D - Clin Interv Aging (2008)

Persistence refers to the duration of time during which a medication is taken. Compliance is the proportion of medication taken at a given time according to instructions while persistent. Adherence represents compliance over time and can be estimated within discrete periods using the medication possession ratio. Reproduced with permission from Badamgarav E, Fitzpatrick LA. 2006. A new look at osteoporosis outcomes: the influence of treatment, compliance, persistence, and adherence. Mayo Clin Proc, 81:1009–12. Copyright © 2006 Mayo Foundation for Medical Education and Research. All rights reserved.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2546473&req=5

fig4: Persistence refers to the duration of time during which a medication is taken. Compliance is the proportion of medication taken at a given time according to instructions while persistent. Adherence represents compliance over time and can be estimated within discrete periods using the medication possession ratio. Reproduced with permission from Badamgarav E, Fitzpatrick LA. 2006. A new look at osteoporosis outcomes: the influence of treatment, compliance, persistence, and adherence. Mayo Clin Proc, 81:1009–12. Copyright © 2006 Mayo Foundation for Medical Education and Research. All rights reserved.
Mentions: Compliance describes the quality of intake of a given medication and considers the extent to which a dosing regimen and its associated instructions are followed. Compliance can often be quantified by a surrogate measure, the medication-possession ratio (MPR), which is the number of days of available medication divided by the number of days of study follow-up. Persistence describes the length of time patients continue to take their medication, and is defined as the time from treatment initiation to treatment completion/discontinuation. Adherence is a summary term that is determined by compliance and persistence of medication intake and describes the extent and the quality of medication intake (see Figures 3 and 4) (Badamgarav and Fitzpatrick 2006; Payer et al 2007). Adherence to medication in postmenopausal osteoporosis is in line with the general finding of low persistence rates in other chronic diseases (Reginster and Rabenda 2006).

Bottom Line: However, treatment effects in an individual patient and cost-effectiveness in public health perspective are vitally dependent on the long-term patient adherence as well as on compliance and persistence.Treatment acceptance could be further improved by IV bisphosphonates with their benefit of only quarterly, or even once-yearly, application.In addition, to ensure best possible patient adherence and maximum treatment benefits, physicians should consider individual patient conditions affecting compliance and persistence as well as patient preferences.

View Article: PubMed Central - PubMed

Affiliation: Center for Muscle and Bone Research, Campus Benjamin Franklin, Charité - University Medicine Berlin, Berlin, Germany. oliver.bock@charite.de

ABSTRACT
Nitrogen-containing bisphosphonates are potent inhibitors of osteoclastic bone resorption. With their individually proven efficacy to significantly reduce the incidence of vertebral and/or non-vertebral fractures and with their overall beneficial safety profile, alendronate, ibandronate, risedronate, and zoledronate are considered today a treatment of first choice in postmenopausal osteoporosis. However, treatment effects in an individual patient and cost-effectiveness in public health perspective are vitally dependent on the long-term patient adherence as well as on compliance and persistence. As compliance and persistence with daily oral bisphosphonates are shown to be suboptimal in many patients, leading to an increased fracture incidence in non-compliant patients, there is a need to improve overall adherence for bisphosphonate treatment in order to achieve maximum treatment effects. One option is to extend dosing intervals to weekly (alendronate, risedronate) or monthly (ibandronate) oral regimens. Less frequent oral regimens are generally preferred by majority of patients. Another alternative is intravenous, instead of oral application (ibandronate, zoledronate). Treatment acceptance could be further improved by IV bisphosphonates with their benefit of only quarterly, or even once-yearly, application. Treatment decisions should be based on anti-fracture efficacy data first. In addition, to ensure best possible patient adherence and maximum treatment benefits, physicians should consider individual patient conditions affecting compliance and persistence as well as patient preferences.

Show MeSH
Related in: MedlinePlus