Exp Clin Endocrinol Diabetes 2015; 123 - P06_02
DOI: 10.1055/s-0035-1547683

Shared-decision-making: The impact of decisions on persistence in osteoporosis therapy

K Schlammerl 1, V Seifert-Klauss 1
  • 1Interdisziplinäres Osteoporosezentrum, Frauenklinik der Technischen Universität München, Klinikum Rechts der Isar

Background: Persistence (percentage of patients remaining on their initially prescribed medication) in osteoporosis therapy is poor. Within one year 34% of the patients on oral and 61% on i.v. medication stop taking them. In the process of shared-decision-making (SDM) patients decide together with their physician about their medication. This project investigated

how the decision influences persistence.

Methods: The decisions of 79 patients (age 35 to 89yrs., mean-age 67) with an externally prescribed specific medication for at least 12 months and of 26 osteoporosis-medication-naive patients (age 29 to 86yrs., mean-age 65) were retrospectively analyzed. The rates of persistence, therapy discontinuation and change of medication over the course of one year were compared.

Results: 26 patients (32.9%) decided to continue the externally prescribed prior medication. 28 (35.4%) changed their therapy and 17 (21.5%) restarted a medication after discontinuation. 8 patients (10.1%) paused with therapy (drug holiday). All 26 patients without prior osteoporosis medication started one in the IOZ. The rates of persistence, therapy discontinuation and change of medication are shown in the table.

therapy continuation by IOZ (n = 26)

therapy change by IOZ (n = 28)

therapy restart by IOZ (n = 17)

therapy started in IOZ (n = 26)

Persistence

61.5% (n = 16)

75.0% (n = 21)

52.9% (n = 9)

57.7% (n = 15)

Medication change

23.1% (n = 6)

17.9% (n = 5)

29.4% (n = 5)

23.1% (n = 6)

Medication discontinuation

15.3% (n = 4)

7.1% (n = 2)

17.6% (n = 3)

19.2% (n = 5)

Conclusion: Persistence was lowest (52.9%) in patients restarting a therapy after discontinuation and highest (75.0%) if a therapy change was jointly decided with the IOZ-physician. The trend for a subsequent change in medication is inverse. Adjusting medication to the needs of patients may improve continuation of specific osteoporosis therapy and could therefore contribute to reducing osteoporosis related fractures.