Low perception of the risk of a fracture is leading to poor medication compliance in the management of osteoporosis, according to a new study published in Australian Family Physician.

A literature review of treatment options and factors contributing to poor patient treatment adherence by Charles A Inderjeeth, Andrisha-Jade Inderjeeth and Warren David Raymond found that while antiresorptive therapy is effective in preventing fractures, patients are not taking their medication properly.

“Fragility fractures are a common cause of hospitalisation, with significant cost, morbidity and mortality,” the author wrote, noting the benefit of preventive treatment is well documented.

The key reasons the authors identified for non compliance were a lack of patient understanding of their condition, perception of fracture risk and concerns about adverse events.

While some patients simply forget to take their medication, others are choosing not to take it, the authors wrote.

“Less than 20 per cent of women and 10 per cent of men with osteoporotic fractures receive treatment. Half do not take their treatment as prescribed and 47 per cent discontinue therapy within six months,” they said in the article.

While the authors found multiple reasons for poor adherence, including patient perception, side effects and dosing intervals, the major reasons include asymptomatic disease manifestation (‘silent disease’) and an underestimation of the risk of fracture.

In particular, the authors cited a the Global Longitudinal Study of Osteoporosis in Women, which found only half of women with osteoporosis who are receiving treatment perceived themselves to be at increased risk of fracture despite having multiple risk factors.

The authors are calling on medical professionals to improve patient education about osteoporosis and talk to patients more often about medication compliance. This includes regular follow-up, risk assessment and treatment monitoring.

“The patient–provider relationship is critical through regular follow up and review of disease risk, progression, patient characteristics and preference, and treatment options. Strategies to improve adherence include discussing novel drug formulations (e.g. delayed-release enteric coating) and the use of parenteral options. This is evident in the shift to the preference for six-monthly denosumab over bisphosphonates. A clinician protocol for ongoing patient risk–benefit assessment and re-evaluation at each successive appointment is essential,” the authors concluded.