The University of Southampton
University of Southampton Institutional Repository

Non-compliance: the Achilles' heel of anti-fracture efficacy

Seeman, E., Compston, J., Adachi, J., Brandi, M.L., Cooper, C., Wson-Hughes, B., Jonsson, B., Pols, H. and Cramer, J.A. (2007) Non-compliance: the Achilles' heel of anti-fracture efficacy Osteoporosis International, 18, (6), pp. 711-719. (doi:10.1007/s00198-006-0294-8).

Record type: Article


About 50% of patients fail to comply or persist with anti-osteoporosis treatment regimens within 1 year. Poor compliance is associated with higher fracture rates. Causes of poor compliance are unknown. As it is not possible to predict poor compliance, close monitoring of compliance is needed. Despite evidence supporting the anti-fracture efficacy of several pharmacological agents, approximately 50% of patients do not follow their prescribed treatment regimen and/or discontinue treatment within 1 year. Poor compliance is associated with higher fracture rates and increased morbidity, mortality and cost. However, as poor compliance, even to placebo, is associated with adverse outcomes, the higher morbidity appears to be only partly the result of lack of treatment: as yet, undefined characteristics place poor compliers at higher risk of morbidity and mortality. Only a small proportion (e.g., 6%) of the variability in compliance is explained by putative causal factors such as older age, co-morbidity or greater number of medications. Regimens with longer dosing intervals, such as weekly dosing, improve compliance, persistence and outcomes, but only modestly. As it is not possible to predict poor compliance, close monitoring of compliance should be an obligatory duty in clinical care. How this is best achieved has yet to be established, but poor persistence occurs as early as 3 months of starting treatment, indicating the need for early monitoring.

Full text not available from this repository.

More information

Published date: 2007
Keywords: risk factors, complications, bone, research, female, bone density, review, fractures, bone density conservation agents, health, patient compliance, Australia, mortality, osteoporosis, comorbidity, humans, risk, prevention & control, etiology, therapeutic use, drug therapy


Local EPrints ID: 61502
ISSN: 0937-941X
PURE UUID: c1c669e7-8912-4d34-a473-4d2cd568fe2c
ORCID for C. Cooper: ORCID iD

Catalogue record

Date deposited: 09 Sep 2008
Last modified: 17 Jul 2017 14:21

Export record



Author: E. Seeman
Author: J. Compston
Author: J. Adachi
Author: M.L. Brandi
Author: C. Cooper ORCID iD
Author: B. Wson-Hughes
Author: B. Jonsson
Author: H. Pols
Author: J.A. Cramer

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.