Determinants of Observance to Osteoporosis Treatment in Clinical Practice in a Single Center Study

Background: Improve compliance to prescribed medications is common in clinical practice, and it can lead to potentially fatal outcomes. This continues to be a common issue in the treatment of osteoporosis, although the causes of discontinuation and low compliance are complicated and understudied.Material & Methods:A survey was conducted in 101 patients at Narsingdi Sadar Hospital, Narsingdi, Dhaka, Bangladesh for osteoporosis management for a follow-up assessment, one year (July 2020 to June 2021) after having been prescribed a treatment with one of the following drugs: Calcium+vitamin D supplements alone (CaVitD), hormone replacement therapy (HRT), risedronate 5 mg/day (RIS), alendronate (ALN OW), Ibandronic acid monthly and Zolindronic acid I/V inj yearly.Results:Overall, 19.1 % stopped taking their prescribed medication before their bone mass reevaluations, with more than half of them doing so within the first 6 months. The dropout rate differed dramatically between regimens. ALN-OW was by far the least interrupted (6.9 %; p0.001 versus any other treatment). The most common causes for cessation were drug-related side effects, a lack of willingness to continue therapy, and a fear of negative effects. The reasons for discontinuation differed by treatment: safety concerns were very common for HRT, lack of motivation was the most common cause for CaVitD and drug-related side effects were the most common cause for RIS, ALN, Ibandronic acid and Zolindronic acid . Patients having a history of vertebral fractures, densito-metric osteoporosis, or who were using corticosteroid or anti-inflammatory medications had a considerably greater rate of treatment adherence. Patients on benzodiazepine or gastroprotective drugs, as well as those for whom a bone measurement was not easily accessible, had a considerably greater probability of treatment interruption. ALN OW and HRT had the highest compliance to recommended dosing (p0.001 versus any other) and CaVitD had the lowest (p0.01 versus any other). Poor treatment compliance (50 percent medicine taken) was strongly associated with benzodiazepine and gastroprotective usage, whereas significantly higher compliance was associated with established osteoporosis risk factors: early menopause, low bone mass values, and past vertebral fractures. Adherence was lowest when treatments were prescribed by general practitioners (GPs) and orthopaedic surgeons (p0.01 compared to the global mean).Conclusions:According to the conclusions of this large survey of Bangladeshi osteoporotic women, the kind of medicine provided is the most important factor of both persistence