title: A systematic review of persistence and compliance with bisphosphonates for osteoporosis.
abstract: Fourteen reports utilizing data from de-identified administrative databases were reviewed. Studies contained at least one measure of patient persistence or compliance with bisphosphonates or bisphosphonates and other anti-osteoporosis medications. These studies confirm that women with osteoporosis have suboptimal persistence and compliance rates with bisphosphonate therapy.
  
  
  BACKGROUND
  This review summarizes patient persistence and compliance with bisphosphonates for the treatment of osteoporosis.
  
  
  METHODS
  We conducted a MEDLINE search for the period from January 1998 to May 2006, using a detailed list of terms related to persistence and compliance with anti-osteoporosis medications. Studies were included if they contained at least one measure of persistence or compliance derived from de-identified administrative databases containing patient demographics and prescription information.
  
  
  RESULTS
  We reviewed 14 reports, which described 14 databases. The percentage of patients persisting with therapy for 1 year ranged from 17.9% to 78.0%. Compliance, assessed as mean medication possession ratio (MPR), ranged from 0.59 to 0.81. When comparing compliance with weekly and daily bisphosphonates, the mean MPR was consistently higher for weekly versus daily therapy (0.58 to 0.76 versus 0.46 to 0.64 for patients receiving weekly and daily bisphosphonate therapy respectively). Persistence was also improved in patients receiving weekly bisphosphonates, assessed by both length of persistence (194 to 269 days [weekly] and 134 to 208 days [daily]) and percentage of persistent patients at the end of the follow-up period (35.7% to 69.7% [weekly] and 26.1% to 55.7% [daily]).
  
  
  CONCLUSIONS
  Although patients using weekly bisphosphonate medication follow their prescribed dosing regimens better than those using daily therapy, overall compliance and persistence rates were suboptimal.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516-2770, USA. joyce.cramer@yale.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Cramer
authors.forename: D T
authors.initials: DT
authors.lastname: Gold
authors.forename: S L
authors.initials: SL
authors.lastname: Silverman
authors.forename: E M
authors.initials: EM
authors.lastname: Lewiecki
mesh_terms: D000328:Adult; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D004164:Diphosphonates / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000523:psychology; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates