title: How can osteoporosis patients benefit more from their therapy? Adherence issues with bisphosphonate therapy.
abstract: OBJECTIVE
  To review the evidence on adherence with bisphosphonates and evolving dosing strategies for osteoporosis treatment.
  
  
  METHODS
  Articles were identified by searching MEDLINE (1975-December 2005) using the following terms: osteoporosis, postmenopausal, fracture, adherence, compliance, persistence, drug therapy, bisphosphonates, alendronate, risedronate, ibandronate, and zoledronate. Additional data included bibliographies from identified articles.
  
  
  METHODS
  All pertinent English-language articles that discussed adherence issues in patients with osteoporosis were included. Both those that reviewed overall issues of medication adherence in osteoporosis and those that focused specifically on adherence to bisphosphonates were included, as were articles that addressed strategies for overcoming nonadherence.
  
  
  RESULTS
  Inadequate diagnosis and treatment of osteoporosis result in a higher risk of fractures than is necessary. Even patients who are diagnosed and beginning treatment often do not persist with their osteoporosis medication because they perceive their fracture risk to be low and, given the asymptomatic nature of osteoporosis, do not experience the benefit of symptom reduction after taking the drugs. Factors that affect adherence to osteoporosis therapy include drug costs, adverse effects, dosing frequency, disease education, patient follow-up, and patient involvement in treatment decisions.
  
  
  CONCLUSIONS
  By considering and implementing strategies that can improve adherence and persistence, primary care providers and pharmacists (via counseling) may enhance long-term outcomes for patients with osteoporosis.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Deborah T
authors.initials: DT
authors.lastname: Gold
authors.forename: Ivy M
authors.initials: IM
authors.lastname: Alexander
authors.forename: Mark P
authors.initials: MP
authors.lastname: Ettinger
mesh_terms: D000328:Adult; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy*; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis / Q000188:drug therapy; D010349:Patient Compliance; D010353:Patient Education as Topic
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates