Adherence to bisphosphonates in the general population: a study in patients referred to a primary care service

Purpose: The aim of the study was to evaluate the adherence to treatment with bisphosphonates in women with postmenopausal osteoporosis referred to a primary care clinic. Methods: A total of 7257 outpatients were referred to the primary care service where the study was conducted. We retrieved data of postmenopausal women to which bisphosphonates have been prescribed in the period January 1, 2000–December 31, 2014, and analyzed the group of patients who had discontinued the drug. Results: The total number of women treated with bisphosphonates was 285 (mean age 72 ± 9.8 years). At the time the data were retrieved, 157 (55% of the total) had discontinued therapy. Among them, 119 (41.7%) agreed to participate in the study. They reported the following reasons for treatment discontinuation: withdrawal by another physician (40%), lack of motivation (20%), absence of BMD improvement (14%), uncomfortable way of drug administration (11%), side effects (6%), fear of side effects (1.6%), high number of concomitant medications (0.8%), and others (6.6%). Sixty patients (50.4%) discontinued therapy within 2 years, 27 patients (23%) > 2 and ≤ 5 years and 32 (27%) after 5 years. Conclusions: Our study demonstrates that more than half of women with postmenopausal osteoporosis referred to a primary care service discontinued bisphosphonates before the clinical effect can be seen and mostly because of advice by physicians not initially prescribing the drug. There is an inappropriate management of bisphosphonate therapy in terms of therapeutic efficacy and strategies aimed at ameliorating clinical management of osteoporosis patients are warranted.