title: Adherence to oral bisphosphonates: 30 more minutes in dosing instructions matter.
abstract: OBJECTIVE
  Low adherence to treatment with bisphosphonates significantly impedes its effectiveness. The objectives were: (1) to compare adherence to oral weekly and monthly bisphosphonates with emphasis on dosing instructions; and (2) to study associations between adherence and beliefs about the bisphosphonate treatment among women ≥ 55 years.
  
  
  METHODS
  A multicenter survey was performed in secondary-care patients with osteoporosis. Osteoporosis Specific Morisky Medication Adherence Scale (OS-MMAS), questions on compliance with five dosing instructions and Beliefs about Medicines Questionnaire (BMQ) Specific were used.
  
  
  RESULTS
  As many as 363 questionnaires (response rate 95%) were analyzed. Respondents (mean age 69 years) were treated with weekly bisphosphonates (37%) or monthly ibandronate (63%). Based on OS-MMAS, 67% of respondents showed high adherence with no differences between the subgroups. Only 44% of respondents were compliant with all dosing instructions. Compliance with dosing instructions concerning time interval (fasting and staying upright) was 71% in weekly and 52% in monthly subgroups, respectively (p < 0.001). Compliance with dosing instructions correlated positively with education (p = 0.009). The mean BMQ necessity score of 18.4 was greater than the mean BMQ concerns score of 13.3. OS-MMAS score correlated with necessity (p = 0.010). Persistence derived from OS-MMAS correlated with both necessity (p = 0.014) and concerns (p = 0.041).
  
  
  CONCLUSIONS
  Despite relatively high adherence to the treatment, most patients do not follow dosing instructions. Reduced bioavailability, particularly of monthly ibandronate, can be expected in clinical practice. Adherence-related outcomes are associated with beliefs about the oral treatment with bisphosphonates.
authors.affiliation: Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague , Hradec Kralove , Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Vytrisalova
authors.forename: T
authors.initials: T
authors.lastname: Touskova
authors.forename: K
authors.initials: K
authors.lastname: Ladova
authors.forename: L
authors.initials: L
authors.lastname: Fuksa
authors.forename: V
authors.initials: V
authors.lastname: Palicka
authors.forename: P
authors.initials: P
authors.lastname: Matoulkova
authors.forename: P
authors.initials: P
authors.lastname: Horak
authors.forename: J
authors.initials: J
authors.lastname: Stepan
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D000077557:Ibandronic Acid; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000523:psychology; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077557:Ibandronic Acid
keywords: DOSING INSTRUCTIONS; DOSING INTERVAL; MEDICATION ADHERENCE; NECESSITY-CONCERNS FRAMEWORK; ORAL BISPHOSPHONATES; OSTEOPOROSIS