ORIGINAL ARTICLE Factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis: a cross-sectional survey A. J. Carr & P. W. Thompson & C. Cooper Received: 12 October 2005 / Accepted: 17 May 2006 / Published online: 1 August 2006 # International Osteoporosis Foundation and National Osteoporosis Foundation 2006 Abstract Objective To determine the factors associated with adherence and persistence to bisphosphonate therapy in osteoporosis. Design Cross-sectional survey. Setting National survey in the UK. Participants Participants were recruited through the National Osteoporosis Society and advertisements in the press and on the radio and included 533 women over age 50 with osteo- porosis who were currently taking or had taken bisphos- phonate therapy within the previous 12 months. Main outcome measures Self-reported factors influencing adherence and persistence to bisphosphonate therapy in osteoporosis: fracture history, pain, practical difficulties taking medication (frequency of dosing, dealing with comedications, impact on daily routine), perceptions of therapy, and concerns about bisphosphonate therapy. Results Adherence to bisphosphonate therapy was 48% and was associated with previous fracture [odds ratio (OR) 1.62, 95% confidence interval (CI) 1.14–3.02], concerns about medication (OR 1.49, 95% CI 1.01–2.20), and less dis- satisfaction with medication (OR 0.65, 95% CI 0.44–0.97). Nonpersistence was associated with dissatisfaction with medication (hazard ratio (HR) 1.83, 95% CI 1.38–2.43), side effects (HR 3.69, 95% CI 2.74–4.97), and concerns about bisphosphonate therapy (HR 2.21, 95% CI 1.48–3.30). For both daily (HR 1.53, 95% CI 1.1–2.33) and weekly bisphosphonates (HR 1.90, 95% CI 1.17–3.07), practical difficulties taking bisphosphonate medication—in par- ticular, too frequent dosing—were associated with nonpersistence. Conclusions Self-reported nonadherence to daily and week- ly bisphosphonates is independent of the decision to stop taking treatment (nonpersistence). Nonpersistence is associ- ated with side effects and other factors that could be modified in clinical practice through education, information, and concordant partnerships. Keywords Adherence . Bisphosphonates . Compliance . Osteoporosis . Patient preference Introduction Bisphosphonates are the main treatment for preventing fractures in osteoporosis, but nonadherence to treatment is common and similar to that in other therapy areas. Nonadherence reduces the effectiveness of treatment and exposes patients to an increased risk of fracture [1] with consequently increased rates of hospitalisation and use of healthcare services, or to multiple changes in therapy because of lack of effectiveness. Osteoporos Int (2006) 17:1638–1644 DOI 10.1007/s00198-006-0166-2 A. J. Carr Academic Rheumatology, Nottingham University, Clinical Sciences Building, City Hospital, Nottingham NG5 1PB, UK P. W. Thompson Poole NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK C. Cooper MRC Epidemiology Resource Centre, Southampton University Medical School, Tremona Road, Southampton SO16 6YD, UK A. J. Carr (*) Clinimatrix, Hale House, Hale House Lane, Churt, Surrey GU10 2JQ, UK e-mail: Alison.Carr@wgclinimatrix.co.uk