Patient compliance with drug therapy for postmenopausal osteoporosis

To determine compliance and factors affecting compliance to antiresorptive drugs in osteoporosis, and to compare compliant and non compliant groups in a tertiary care setting. Cross sectional study from May 2004 to April 2007. Hamdard University Hospital, Karachi. A total of 800 patients with postmenopausal osteoporosis were included in the study. The demographic and reproductive characteristics of all the patients were recorded Type of anti-resorptive drugs prescribed, degree of compliance, time and reasons for discontinuation were studied and analyzed. Results: The mean age of the patients was 64 [ +/- 9] years and their mean duration of follow-up 18 [ +/- 5] months. The prevalence of risk factors for osteoporosis were evenly distributed among treatment groups; 73% patients had a co-morbidity besides osteoporosis while 27% were osteoporotic alone. One or more previous vertebral fractures due to osteoporosis was reported by 14.5% of patients, whereas 35.5% had at least one non-vertebral fracture in their medical history. Out of the total patients 21.5% discontinued the prescribed drug before attending the bone mass re-evaluations, more than half of these within first six months of starting the drugs. The medication that was most frequently discontinued within one year was calcium and vitamin-D [33.7%, p < 0.01] while the least discontinued medication was Alendronate [5.9%, p < 0.01] which is taken once a week. In this study the most important determinant of compliance was the type of drug prescribed and its dose frequency, with a definite preference for Alendronate once a week. Treatment compliance was particularly poor for calcium and vitamin-D regimen, thereby emphasizing the need to find new ways of administering supplements, particularly for vitamin-D

Depression in medical in-patients

This study was conducted to detect the prevalence of depression in medical inpatients staying for more than one week in the hospital and to assess the possible role of depression in prolonging the stay of the patients in the hospital. Two hundred and ninety eight patients with over a week stay in the hospital were screened for probable depression during three months with Hospital Anxiety and Depression Scale [Depression Subscale] and consequently they were assessed by two psychiatrists twice at 1 week interval with clinical interview and Hamilton Depression Rating Scale. Final diagnosis was made by using the ICD-30 diagnostic criteria. Depression in some form was detected in 39.26% of the total patients including major depression in 9.73% of the total patients. The hospital stay of the patients showed significant relation with depression. The substantial prevalence of depression with its significant association with longer hospital stay in medical inpatients requires greater cognizance and attention by simple screening instruments like HADS and subsequent liaison with the psychiatrist in selected cases for its appropriate management. This may help in improving the patient's physical and psychological health and reducing the hospital stay and costs. Future sound methodological studies are needed to explore the possible therapeutic and economic benefits of screening the patients in the medical wards for depression