Optimising Long-term Management

As with many other chronic conditions, approximately half of patients prescribed treatments for osteoporosis stop treatment within 12 months. Many fail to tell their GP or health professional that they have stopped taking their medication. Most who stop therapy do so within the first few months and the median duration of oral therapy is 1.2 years.

Studies have shown that there is a discrepancy between health professionals' perceptions of the reasons for poor compliance and those cited by patients. Studies have indicated that health professionals think that lack of understanding is the driving force for stopping medication while patients state that it is the difficulty of taking the medication, side effects and convenience-related factors that determine compliance and persistence in therapy. We also need to recognise that some patients will simply not want to take drug treatments for prolonged periods.

Factors responsible for poor adherence and persistence are not well understood and patients may discontinue therapy for a number of reasons. This is often multi-factorial in aetiology and results from a combination of the following factors:

  • Lack of motivation to continue medication
  • Adverse effects
  • Inconvenient dosing
  • Safety concerns and adverse publicity

Encouraging patients to report difficulties (real or perceived) so that these can be discussed along with possible options and solutions can promote better adherence and persistence. Giving patients written information regarding their medication (how the medication works, the correct way in which it has to be taken, the potential side effects and what to do if they occur) can also encourage patients to continue with medication. Following patients up and advising them that this will be the case gives them the opportunity to discuss any difficulties they may have and many will persist in the short term until this review takes place. Such reviews are increasingly being done by telephone and studies have shown that compliance improves where patients are contacted by nurses 6 to 8 weeks after commencing therapy to see how they are faring with the medication prescribed for them. This not only engenders feelings of support and interest but reinforces the importance of persisting with and adhering to treatment regimes. Compliance has been shown to be improved to 81% at 18 months after starting treatment within Fracture Liaison Services where specialist nurses contact the patient at standardised intervals to problem-solve and remind patients regarding medication.