The real-world adherence of the first-line anti-osteoporosis medications in Taiwan: Visualize the gap between reality and expectations

Chia-Che Lee; Shau-Huai Fu; Ho-Min Chen; Jou-Wei Lin; Chih-Cheng Hsu; Sheng-Chieh Lin; Jawl-Shan Hwang; Rong-Sen Yang; Chih-Hsing Wu; Chen-Yu Wang

Journal of the Formosan Medical Association (Jan 2023)

The real-world adherence of the first-line anti-osteoporosis medications in Taiwan: Visualize the gap between reality and expectations

Chia-Che Lee,
Shau-Huai Fu,
Ho-Min Chen,
Jou-Wei Lin,
Chih-Cheng Hsu,
Sheng-Chieh Lin,
Jawl-Shan Hwang,
Rong-Sen Yang,
Chih-Hsing Wu,
Chen-Yu Wang

Affiliations

Chia-Che Lee: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
Shau-Huai Fu: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Ho-Min Chen: Health Data Research Center, National Taiwan University, Taipei, Taiwan
Jou-Wei Lin: Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Yunlin County, Taiwan
Chih-Cheng Hsu: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan
Sheng-Chieh Lin: Department of Orthopedic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
Jawl-Shan Hwang: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan; Department of Orthopedics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Health Data Research Center, National Taiwan University, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Yunlin County, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; Department of Orthopedic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Orthopaedics, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
Rong-Sen Yang: Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopaedics, College of Medicine, National Taiwan University, Taipei, Taiwan
Chih-Hsing Wu: Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Corresponding author. 138 Sheng-Li Road, Tainan, 70428, Taiwan.
Chen-Yu Wang: National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin County, Taiwan; Department of Pharmacy, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Corresponding author. No. 8, Xuefu W. Rd., Huwei Township, Yunlin County 632, Taiwan.

Journal volume & issue: Vol. 122
pp. S55 – S64

Abstract

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Background: Adherence to anti-osteoporosis medications (AOMs) is crucial. National Health Insurance (NHI) in Taiwan has its own rules of reimbursement rule for AOMs. The midterm adherence remained inconclusive. Here we investigated the adherence according to the initially used AOMs, for three consecutive years. Methods: The nationwide cohort study from 2008 to 2018, based on Taiwan's National Health Insurance Research Database, included 336,229 patients. Their adherence, indicated by medication possession ratio (MPR), to the initial AOMs was investigated yearly for three consecutive years. The overall MPRs (OMPR), including the switched AOMs, were also calculated in the first year. The Sankey diagram further visualized the patient flows toward different adherence according to the initial AOMs. Results: The OMPR in the first year improved if the patients used AOMs with longer dosing intervals. 100%, 68.9%, 40.7%, and 34.0% of the patients started the treatment with zoledronate, denosumab, alendronate, and raloxifene, respectively, had OMPR ≥75% in the first year. In the 3rd year, only 20.89%, 24.13%, and 12.83% of the patients continuously treated with zoledronate, denosumab, and alendronate, respectively, had MPR ≥75%. From the Sankey diagram, we also observed that patients who had poor adherence at one year were inclined to have poor adherence or discontinue antiosteoporosis treatment in the next year. Conclusion: The initial AOMs and the observed adherence may provide clues for optimizing patient treatment. The real-world adherence in Taiwan was far from satisfactory in our study.

Published in Journal of the Formosan Medical Association

ISSN: 0929-6646 (Print)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Medicine (General)
Website: http://www.journals.elsevier.com/journal-of-the-formosan-medical-association/

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