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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

IOF Survey 2005: Patient drawbacks associated with oral bisphosphonates. Some patients stated more than one drawback. (Derived from IOF 2005).
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getmorefigures.php?uid=PMC2546473&req=5

fig6: IOF Survey 2005: Patient drawbacks associated with oral bisphosphonates. Some patients stated more than one drawback. (Derived from IOF 2005).

Mentions: A survey carried out for the International Osteoporosis Foundation (IOF) by IPSOS Health in 2005 aimed to understand the reasons why women with osteoporosis do not stay on treatment. It showed that 34% of women interviewed either did not know what the benefits of their medication were or wrongly thought there were no benefits at all. As patients often have no symptoms until they suffer a fracture, they do not feel that treatment is worth taking or do not believe they have a disease that needs treatment. This means they may consider the pill burden and the inconvenience of the dosing requirements to be unnecessary. Drawbacks of treatment identified by women were predominantly related to inconvenience and side effects (IOF 2005) (see Figure 6).


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

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

IOF Survey 2005: Patient drawbacks associated with oral bisphosphonates. Some patients stated more than one drawback. (Derived from IOF 2005).
© Copyright Policy
Related In: Results  -  Collection

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

fig6: IOF Survey 2005: Patient drawbacks associated with oral bisphosphonates. Some patients stated more than one drawback. (Derived from IOF 2005).
Mentions: A survey carried out for the International Osteoporosis Foundation (IOF) by IPSOS Health in 2005 aimed to understand the reasons why women with osteoporosis do not stay on treatment. It showed that 34% of women interviewed either did not know what the benefits of their medication were or wrongly thought there were no benefits at all. As patients often have no symptoms until they suffer a fracture, they do not feel that treatment is worth taking or do not believe they have a disease that needs treatment. This means they may consider the pill burden and the inconvenience of the dosing requirements to be unnecessary. Drawbacks of treatment identified by women were predominantly related to inconvenience and side effects (IOF 2005) (see Figure 6).

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