What Are The Factors That Influence Adherence to Medications for Osteoporosis?

Despite the fact that osteoporosis is a growing public health problem in the United States and worldwide, there is poor adherence to medications to treat the problem. A recent study published in Osteoporosis International identified the factors that influence patient adherence to therapy, many of which are modifiable.

Previous research has indicated that adherence is influenced by a number of issues, including side effects, cost of the medication, dosing frequency, and routes of administration. Other factors include patient beliefs, demographics and comorbidities. Some studies have also identified a perceived lack of benefit from the medications.

Understanding these factors can help providers improve therapeutic outcomes for patients, the researchers noted.

For this study, researchers used the World Health Organization’s 5 dimensions of medication adherence (condition, patient, therapy, health system, and socioeconomic) as a classification system. They conducted a literature review for peer-reviewed articles in 4 databases looking at adherence involving anti-osteoporotic therapy, including bisphosphonates, parathyroid hormone-related analogue, denosumab, selective estrogen receptor modulators, estrogen/progestin therapy, calcitonin, and strontium ranelate.

Of 2404 articles reviewed, 124 relevant articles were identified. The prevalence of medication adherence ranged from 12.9% to 95.4%. Twenty-four factors with 139 subfactors were identified. Bisphosphonates were the most well-studied class of medication (n = 59, 48%).

Overall, factors identified that were associated with poorer medication adherence included polypharmacy, older age, and misconceptions about osteoporosis.

Condition-related factors

Condition-related factors that were associated with poorer medication adherence included polypharmacy, having comorbid conditions, and having psychiatric conditions such as depression. However, a history of falls was associated with higher medication adherence, as was having a history of screening.

Patient-related factors

There were 6 main factors relating to patients were demographics, physical and mental function, disease and treatment, family history, and menopausal factors. Having lower education levels was linked to poorer medication adherence. Poorer medication adherence was also linked to higher age of menopause.

Disease and treatment perceptions included misconceptions about osteoporosis and the lack of perceived benefit of therapy.

Health system-based factors

Health system-based factors associated with poorer medication adherence included care under different medical specialties and a lack of patient education. Poor accessibility to medication was also considered a factor.

Socioeconomic-related factors

Socioeconomic-related factors included location of residence and current smoking status. In addition, high treatment cost affected medication adherence. The financial condition of patients should be assessed by physicians when prescribing antiosteoporotic medications which are more expensive than others, and patients should be referred to social services if necessary.

Therapy-related factors

Therapy-related factors included higher dosing frequency and medication side effects.

Clinicians should keep these factors in mind in order to achieve high medication adherence in their patients, the researchers said.

Reference

Yeam CT, Chia A, Tan HCC, et al. A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporosis Intl. 2018;29:2623-2637. doi.org: 10.1007/s00198-018-4759-3.