title: Improving adherence in osteoporosis: a new management algorithm for the patient with osteoporosis.
abstract: BACKGROUND
  Bisphosphonates are the first-choice treatment for osteoporosis. They effectively increase bone mineral density, reduce markers of bone resorption, and lower the incidence of new fractures in patients with osteoporosis-related fracture. However, the efficacy observed in clinical trials may not be realized in a real-life setting, partly due to poor adherence to therapy, with a significant worsening of clinical outcomes. Several issues contribute to poor adherence to osteoporosis medication, including inconvenient dosing regimens and concerns about possible adverse events. Although strategies to improve adherence have been investigated, new approaches are required.
  
  
  METHODS
  We review available data and propose a new approach to improve adherence to osteoporosis therapy in clinical practice. We present the current evidence and personal experience from a group of Italian osteoporosis experts.
  
  
  CONCLUSIONS
  To improve adherence, we propose a multifaceted approach, which includes the Triad Model suggested by the World Health Organization, direct observed therapy and the use of drugs with longer administration intervals, e.g., zoledronic acid. The integration of these strategies may provide the basis for a marked increase in adherence to osteoporosis therapy, and improved clinical outcomes in a real-life scenario.
authors.affiliation: University College London, Department of Epidemiology and Public Health, London, UK.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Baio
authors.forename: Mario
authors.initials: M
authors.lastname: Barbagallo
authors.forename: Giovanni
authors.initials: G
authors.lastname: D'Avola
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Luccio
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Di Tanna
authors.forename: Paolo
authors.initials: P
authors.lastname: Falaschi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Iolascon
authors.forename: Nazzarena
authors.initials: N
authors.lastname: Malavolta
authors.forename: Federico
authors.initials: F
authors.lastname: Robbiati
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Ulivieri
mesh_terms: D000465:Algorithms; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002985:Clinical Protocols; D017281:Cost of Illness; D005260:Female; D006801:Humans; D055118:Medication Adherence; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000191:economics; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents