title: Persistence and compliance of medications used in the treatment of osteoporosis--analysis using a large scale, representative, longitudinal German database.
abstract: OBJECTIVE
  Osteoporosis can be effectively treated with a number of medications. However, high persistence and compliance are required to assure efficacy. This study analyses persistence and compliance with a variety of medical interventions including p.o., i.v. and s.c. administrations in Germany.
  
  
  METHODS
  This retrospective cohort study used a representative longitudinal database (IMS® LRx) comprising longitudinal prescription data for Germany from almost 80% of all German prescriptions of members of the German statutory health insurance system. Persistence is defined as the proportion of patients who remained on their initially prescribed therapy at 1 year. Compliance is measured indirectly based on the medication possession ratio (MPR).
  
  
  RESULTS
  A total of more than 1 million patients (1,107,482) for the period 07/2007 - 06/2009 was identified in the database who received a prescription for a bisphosphonate, strontium or PTH. Of these, 268,568 patients fulfilled further inclusion criteria and were included in the persistence and compliance analysis. At 12 months the proportion of patients that remained on treatment were 65.6% for zoledronate 5 mg; 56.6% for ibandronate i.v. 3 mg; 54.7% for PTH (teriparatide and 1-84 PTH), 51.0% for ibandronate 150 mg p.o.; 44.8% for alendronate 70 mg; 43.4% for etidronate. Other values were risedronate plus calcium 42.3%; alendronate plus vitamin D 37.8%; risedronate 35 mg 35.2%; risedronate 5 mg 30.6%; strontium ranelate 31.4% and alendronate 10 mg 17.3%.
  
  
  CONCLUSIONS
  Persistence and compliance during the treatment of osteoporosis were found to be insufficient. Treatment using the intravenous route and PTH showed the highest persistence and compliance rates and daily oral bisphosphonates the lowest. More effort to improve treatment compliance and persistence is needed to assure clinical efficacy.
authors.affiliation: Department of Endocrinology, Reproductive Medicine and Osteoporosis, Philipps-University, Marburg, Germany. ziller@med.uni-marburg.de
authors.forename: Volker
authors.initials: V
authors.lastname: Ziller
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kyvernitakis
authors.forename: Jelena
authors.initials: J
authors.lastname: Boeckhoff
authors.forename: Peyman
authors.initials: P
authors.lastname: Hadji
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D055118:Medication Adherence; D009942:Organometallic Compounds / Q000627:therapeutic use; D010024:Osteoporosis / Q000188:drug therapy*; D010281:Parathyroid Hormone / Q000627:therapeutic use; D012189:Retrospective Studies; D013876:Thiophenes / Q000627:therapeutic use; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009942:Organometallic Compounds; D010281:Parathyroid Hormone; D013876:Thiophenes; C081587:strontium ranelate; D014807:Vitamin D