Long-Term Oral Bisphosphonate Compliance Focusing on Switching of Prescription Pattern
Received 13 June 2020
Accepted for publication 21 September 2020
Published 22 October 2020 Volume 2020:14 Pages 2009—2016
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Johnny Chen
Kyung Rae Ko,1 Sangcheol Lee,2 Seo Yoon Oh,3 Ki-duk Kim,4 Sin Hyung Park,4,* Soonchul Lee2,*
1Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 2Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea; 3University of California, Berkeley, CA 94720, USA; 4Department of Orthopaedic Surgery, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon-si, Gyeonggi-do, Republic of Korea
*These authors contributed equally to this work
Correspondence: Soonchul Lee
Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
Tel +82 31-780-5289
Fax +82 31-708-3578
Sin Hyung Park
Department of Orthopaedic Surgery, Bucheon Hospital, Soonchunhyang University School of Medicine, 170 Jomaru-Ro, Bucheon-si, Gyeonggi-do, Republic of Korea
Tel +82 32-621-5114
Fax +82 32-708-3578
Background: Factors determining bisphosphonate compliance are not fully understood. We examined fluctuations in oral bisphosphonate dosing intervals to gauge therapeutic compliance in patients with osteoporosis.
Materials and Methods: Hospital data accruing between 2010 and 2017 were accessed to retrospectively study patients ≥ 50 years old (N=1873), each prescribed bisphosphonate at initial diagnosis of osteoporosis. The medication possession ratio (MPR), calculated as total days supplied divided by length of follow-up, served to measure therapeutic compliance. We compared MPRs of various prescription patterns (daily, weekly, monthly, and switch [ie, ≥ 1 change in pattern] groups). We also analyzed the impact of age, sex, fracture history, surgical history, and comorbidities. Multiple regression analysis was ultimately performed, using MPR as a dependent variable.
Results: In our cohort (mean follow-up=5.7± 2.4 years), once weekly dosing was the most common prescription pattern (1223/1873, 65.3%), as opposed to monthly (366/1873, 19.5%) or daily (164/1873, 8.8%) dosing. A total of 120 patients (6.4%) comprising the switch group changed dosing patterns during the study period. MPR was significantly higher in the switch group (32.8± 22.7) than in the other three groups (daily, 21.9± 25.9; weekly, 22.7± 27.3; monthly, 23.2± 27.7). In multiple regression analysis, younger age (P< 0.001), female sex (P=0.004), and switching of prescription pattern (decrease or increase frequency) were factors significantly associated with higher MPR, signaling better compliance.
Conclusion: Better bisphosphonate compliance was associated with physician-modified dosing patterns. We therefore recommend adjustments of prescription intervals in poorly compliant patients requiring long-term treatment.
Keywords: bisphosphonate, compliance, medication possession ratio, MPR
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