title: Abandoned acid? Understanding adherence to bisphosphonate medications for the prevention of osteoporosis among older women: a qualitative longitudinal study.
abstract: BACKGROUND
  There is significant morbidity and mortality caused by the complications of osteoporosis, for which ageing is the greatest epidemiological risk factor. Preventive medications to delay osteoporosis are available, but little is known about motivators to adhere to these in the context of a symptomless condition with evidence based on screening results.
  
  
  OBJECTIVE
  To describe key perceptions that influence older women's adherence and persistence with prescribed medication when identified to be at a higher than average risk of fracture.
  
  
  METHODS
  A longitudinal qualitative study embedded within a multi-centre trial exploring the effectiveness of screening for prevention of fractures.
  
  
  METHODS
  Primary care, Norfolk. United Kingdom.
  
  
  METHODS
  Thirty older women aged 70-85 years of age who were offered preventive medication for osteoporosis and agreed to undertake two interviews at 6 and 24 months post-first prescription.
  
  
  RESULTS
  There were no overall predictors of adherence which varied markedly over time. Participants' perceptions and motivations to persist with medication were influenced by six core themes: understanding adherence and non-adherence, motivations and self-care, appraising and prioritising risk, anticipating and managing side effects, problems of understanding, and decision making around medication. Those engaged with supportive professionals could better tolerate and overcome barriers such as side-effects.
  
  
  CONCLUSIONS
  Many issues are raised following screening in a cohort of women who have not previously sought advice about their bone health. Adherence to preventive medication for osteoporosis is complex and multifaceted. Individual participant understanding, choice, risk and perceived need all interact to produce unpredictable patterns of usage and acceptability. There are clear implications for practice and health professionals should not assume adherence in any older women prescribed medication for the prevention of osteoporosis. The beliefs and motivations of participants and their healthcare providers regarding the need to establish acceptable medication regimes is key to promoting and sustaining adherence.
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Salter
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom.
authors.forename: Lisa
authors.initials: L
authors.lastname: McDaid
authors.affiliation: School of Chemistry and Pharmacy, University of East Anglia, Norwich, Norfolk. United Kingdom.
authors.forename: Debi
authors.initials: D
authors.lastname: Bhattacharya
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Holland
authors.affiliation: Rheumatology Department, Norfolk & Norwich University Foundation Trust Hospital. Norwich, Norfolk. United Kingdom.
authors.forename: Tarnya
authors.initials: T
authors.lastname: Marshall
authors.affiliation: Norwich Medical School, Faculty of Medicine & Health Science, University of East Anglia, Norwich, Norfolk, United Kingdom.
authors.forename: Amanda
authors.initials: A
authors.lastname: Howe
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018890:Chemoprevention; D003657:Decision Making; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D055118:Medication Adherence; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology* / Q000517:prevention & control*; D011320:Primary Health Care; D036301:Qualitative Research; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates