Background: Management of osteoporosis is imperfect because patients may not start, persist or comply with treatment. This study aimed to identify baseline variables associated with women failing to start, persist or comply with bisphosphonate treatment.
Methods: 254 women >50yr were selected 5yr after a bone densitometry (BMD) diagnosis of osteoporosis. At the outset information about osteoporosis was sent to the General Practitioner (GP). Women were not under pressure at the outset to start or comply and they and their GP were unaware that follow-up studies would take place. Patient survival was identified from the NHS Strategic Tracing Service; prescription data from GP records and baseline data from the initial questionnaire. Persistence was defined as at least 1 prescription issued/year, compliance as having a medicines possession ratio (MPR) of ≥80% for each of 5yr.
Results: Thirty eight percent failed to start treatment. Failure was associated with higher BMD Z-score and residence in a nursing/residential home (NRH). Half of those starting and alive at 5yr persisted with treatment, whereas only 23% achieved MPR≥80%. Persistence was associated with a lower co-morbidity index and compliance with a lower BMD Z-score and a fall before starting treatment.
Conclusions: Treatment was low, especially in NRH where known low treatment prevalence appears to be associated with non-initiation. The degree of depression of BMD (not just low BMD) was associated with better initiation and compliance. The association of falls with compliance suggests that falls clinics may be able to play a part in improving osteoporosis management.