title: Compliance and persistence with treatment with parathyroid hormone for osteoporosis. A Danish national register-based cohort study.
abstract: Medical intervention is important in the treatment of osteoporosis, and compliance with medical treatment is essential for an optimal outcome. Based on Danish national registers, we found that compliance with parathyroid hormone (PTH) treatment is high and associated with marital status, working status, and type of PTH treatment.
  
  
  OBJECTIVE
  Compliance and persistence are essential for an optimal outcome during medical treatment of osteoporosis. We aimed to evaluate compliance and persistence with treatment with PTH in daily clinical practice in Danish patients and to describe factors affecting compliance.
  
  
  METHODS
  Register-based nationwide cohort study on all patients in Denmark initiates PTH or analogue treatment for osteoporosis in 2003-2010 (n = 4281). PTH drugs included were the PTH analogue teriparatide(1-34) and recombinant human PTH (rhPTH(1-84)). Compliance with treatment was calculated by using medication possession ratio (MPR).
  
  
  RESULTS
  In the study period, 3702 patients were exclusively treated with teriparatide and 579 were exclusively treated with rhPTH(1-84). We found that for patients persistent with therapy for at least 18 months and with MPR >0.8, 83 % of the patients in the teriparatide group were compliant versus 72 % in the recombinant PTH group (p < 0.01). Being married/cohabiting, still in the labor market, and taking teriparatide were significantly associated with higher compliance, whereas age, gender, level of education, income, alcoholism, and Charlson comorbidity index were not associated with compliance.
  
  
  CONCLUSIONS
  Compliance with PTH treatment overall is high, with teriparatide compliance higher than rhPTH(1-84), in patients persistent to therapy for 18 months. Compliance is associated with marital status, working status, and type of PTH treatment.
authors.affiliation: Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400, Hillerød, Denmark. Anne-Luise.Thorsteinsson@regionh.dk.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. Anne-Luise.Thorsteinsson@regionh.dk.
authors.forename: Anne-Luise
authors.initials: AL
authors.lastname: Thorsteinsson
authors.affiliation: Departments of Clinical Medicine and Endocrinology, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
authors.affiliation: Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400, Hillerød, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Pia
authors.initials: P
authors.lastname: Eiken
mesh_terms: D000368:Aged; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000523:psychology; D010281:Parathyroid Hormone / Q000008:administration & dosage*; D012042:Registries; D019379:Teriparatide / Q000008:administration & dosage*
chemical_list: D050071:Bone Density Conservation Agents; C470125:PTH protein, human; D010281:Parathyroid Hormone; D019379:Teriparatide
keywords: Compliance; Osteoporosis; Parathyroid hormone treatment; Persistence