Adherence is a major problem with medications for bone loss. A large meta-analysis of six large observational trials involving 106,961 patients concluded that one-third to one-half of patients did not take their medications for osteoporosis as directed. The vast majority of the poor adherence was in the first three to six months of treatment (Kothawala, 2007). The literature suggests that 45-50% of patients on one of these agents have stopped them within one year (Cramer, 2005). Adherence to therapy was associated with significantly fewer fractures at 24 months (Siris, 2006). The use of follow-up bone densitometry and bone markers have not been shown to improve adherence. Follow-up phone calls or visits have shown improvement in adherence (Cramer, 2006). Several studies support weekly bisphosphonate dosing versus daily, and/or monthly dosing versus weekly to improve compliance (Cooper, 2006; Emkey, 2005; Recker, 2005). It is important to include the patient in discussions related to their treatment options, including rationale, risks and benefits. Shared decision-making (SDM) is a model that facilitates these discussions. Please see Appendix C for more information on this model.
