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Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)

Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)
Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF)
Summary

Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions.

Introduction

Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication.

Methods

A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken.

Results

Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it.

Conclusion

These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.
0937-941X
1-11
Hiligsmann, M.
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Cornelissen, D.
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Vrijens, B.
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Abrahamsen, B.
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Al-Daghri, N.M.
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Biver, E.
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Bruyere, O.
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Burlet, N.
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Cooper, C.
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Cortet, B.
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Kanis, J. A.
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Kaufman, J.M.
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Bruyere, O.
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Burlet, N.
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Cooper, C.
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Cortet, B.
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Dennison, E.
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Diez-Perez, A.
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Gasparik, A.I.
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Grosso, A.
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Kaufman, J.M.
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Laslop, A.
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Rizzoli, R.
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Thomas, T.
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Tüzün, S.
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Vlaskovska, M.
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Reginster, J.-Y.
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Hiligsmann, M., Cornelissen, D., Vrijens, B., Abrahamsen, B., Al-Daghri, N.M., Biver, E., Brandi, M.L., Bruyere, O., Burlet, N., Cooper, C., Cortet, B., Dennison, E., Diez-Perez, A., Gasparik, A.I., Grosso, A., Hadji, P., Halbout, P., Kanis, J. A., Kaufman, J.M., Laslop, A., Maggi, S., Rizzoli, R., Thomas, T., Tüzün, S., Vlaskovska, M. and Reginster, J.-Y. (2019) Determinants, consequences and potential solutions to poor adherence to anti-osteoporosis treatment: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF). Osteoporosis International, 1-11. (doi:10.1007/s00198-019-05104-5).

Record type: Article

Abstract

Summary

Many patients at increased risk of fractures do not take their medication appropriately, resulting in a substantial decrease in the benefits of drug therapy. Improving medication adherence is urgently needed but remains laborious, given the numerous and multidimensional reasons for non-adherence, suggesting the need for measurement-guided, multifactorial and individualized solutions.

Introduction

Poor adherence to medications is a major challenge in the treatment of osteoporosis. This paper aimed to provide an overview of the consequences, determinants and potential solutions to poor adherence and persistence to osteoporosis medication.

Methods

A working group was organized by the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) to review consequences, determinants and potential solutions to adherence and to make recommendations for practice and further research. A systematic literature review and a face-to-face experts meeting were undertaken.

Results

Medication non-adherence is associated with increased risk of fractures, leading to a substantial decrease in the clinical and economic benefits of drug therapy. Reasons for non-adherence are numerous and multidimensional for each patient, depending on the interplay of multiple factors, suggesting the need for multifactorial and individualized solutions. Few interventions have been shown to improve adherence or persistence to osteoporosis treatment. Promising actions include patient education with counselling, adherence monitoring with feedback and dose simplification including flexible dosing regimen. Recommendations for practice and further research were also provided. To adequately manage adherence, it is important to (1) understand the problem (initiation, implementation and/or persistence), (2) to measure adherence and (3) to identify the reason of non-adherence and fix it.

Conclusion

These recommendations are intended for clinicians to manage adherence of their patients and to researchers and policy makers to design, facilitate and appropriately use adherence interventions.

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More information

Accepted/In Press date: 18 July 2019
e-pub ahead of print date: 7 August 2019

Identifiers

Local EPrints ID: 433492
URI: http://eprints.soton.ac.uk/id/eprint/433492
ISSN: 0937-941X
PURE UUID: 39f11e01-e282-46da-b9b0-b9fbf6c44e1d
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for E. Dennison: ORCID iD orcid.org/0000-0002-3048-4961

Catalogue record

Date deposited: 23 Aug 2019 16:30
Last modified: 26 Nov 2021 05:34

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Contributors

Author: M. Hiligsmann
Author: D. Cornelissen
Author: B. Vrijens
Author: B. Abrahamsen
Author: N.M. Al-Daghri
Author: E. Biver
Author: M.L. Brandi
Author: O. Bruyere
Author: N. Burlet
Author: C. Cooper ORCID iD
Author: B. Cortet
Author: E. Dennison ORCID iD
Author: A. Diez-Perez
Author: A.I. Gasparik
Author: A. Grosso
Author: P. Hadji
Author: P. Halbout
Author: J. A. Kanis
Author: J.M. Kaufman
Author: A. Laslop
Author: S. Maggi
Author: R. Rizzoli
Author: T. Thomas
Author: S. Tüzün
Author: M. Vlaskovska
Author: J.-Y. Reginster

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