Komplians ved behandling af osteoporose med bisfosfonat

Introduction: In randomized controlled trials, pharmacological treatment decreases the incidence of fractures in women with postmenopausal osteoporosis by 35-65%. Compliance with treatment in these studies has ranged from 50% to 89%; however, the participants in such trials are highly selected and well motivated, and are offered special services and frequent clinical visits in comparison with patients treated in a clinical setting. We studied compliance with bisphosphonate treatment in a consecutive group of patients with post-menopausal osteoporosis referred from general practice to a secondary and tertiary care centre. Materials and methods: During the two-year study period, 177 postmenopausal women were diagnosed with osteoporosis and were started on bisphosphonate. These patients were invited to participate in the present study by letter. A questionnaire comprising 28 items on how, when, and how often the bisphosphonate was taken and a number of other parameters was mailed to each patient together with a stamped return envelope. Non-responders were reminded after two months. In all, 110 patients responded. Results: At one, two, and three years, 96%, 62%, and 42% of the patients, respectively, were compliant. Most patients (76%) felt adequately informed about the treatment, and these were significantly (p < 0.001) more compliant than those patients who felt inadequately informed. The level of education was positively (p = 0.04) correlated with compliance, whereas adverse effects, price, age and symptom score were unrelated to compliance. Discussion: Our study confirms that compliance with bisphosphonate treatment is considerably lower in clinical practice than among patients participating in randomized studies. The level of education and adequate information about the treatment are the most important predictors of compliance.