If you don't take it – it can't work: the consequences of not being treated or nonadherence to osteoporosis therapy

Abstract

Jonathan D Adachi1, Robert G Josse2, R Graham G Russell3,41Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 2Osteoporosis Center, Division of Endocrinology and Metabolism St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; 3Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University Institute of Musculoskeletal Sciences (The Botnar Research Centre), Nuffield Orthopaedic Center, Oxford, UK; 4The Mellanby Center For Bone Research, Department of Human Metabolism, The University of Sheffield Medical School, Sheffield, UKAbstract: Osteoporosis is a growing problem worldwide, linked to an increasingly aging population. Despite the availability of a wide variety of treatments for osteoporosis, a significant number of patients are either not being prescribed treatment or discontinue therapy as early as 6 months after initiation. The reasons for a lack of adherence are many but poor adherence increases the risk of fracture and, therefore, the disease burden to the patient and society. Results from large-scale, randomized clinical studies have shown that different osteoporosis treatments are efficacious in reducing the risk of fracture. Studies assessing the effects of discontinuing osteoporosis therapies show that some treatments appear to continue to protect patients from the risk of future fracture even when treatment is stopped. However, these trials involve patients who have been compliant with treatment for between 2 and 5 years, a situation not reflective of real-world clinical practice. In reality, patients who discontinue therapy within the first 6 months may never achieve the optimum protection from fracture regardless of which treatment they have been prescribed. Clinicians need to develop management strategies to enable patients to adhere to their treatment. This will ultimately result in better prevention of fracture and a lower burden of disease to society and patients.Keywords: osteoporosis, adherence, treatment, persistence, compliance, fracture