Adherence to alendronic or risedronic acid treatment, combined or not to calcium and vitamin D, and related determinants in Italian patients with osteoporosis

Figures & data

Table 1 Specific drugs used to identify and analyze the cohort of patients with osteoporosis

Definition of therapy for osteoporosis (ATC code)
First-line AODs (AIFA Recommendation number 79)	• Bisphosphonate (M05BA)
	• Alendronic acid (M05BA04)
	• Risedronic acid (M05BA07)
	• Alendronic acid, association with colecalciferol (M05BB)
Calcium and/or vitamin D supplements	• Vitamin D and analogues (A11CC – excluded A11CC02)
	• Calcium (A12AA – excluded A12AA12 and A12AA03)
	• Calcium associated with vitamin D:
	◦ Calcium, associated with vitamin D and/or other drugs (A12AX)
	◦ A11CC + A12AA the same year

Abbreviations: AIFA, Italian Medicines Agency; AODs, antiosteoporosis drugs; ATC, Anatomical Therapeutic Chemical.

Table 2 Demographic characteristics of patients with first-line AODs prescriptions

Antiosteoporosis drug	N	%	Women (%)	Men (%)	<50 years (%)	50–59 years (%)	60–69 years (%)	70–79 years (%)	≥80 years (%)
Alendronic acid	15,521	38.25	87.9	12.1	2.3	11	27	37	22.7
Alendronic acid + colecalciferol (FDC)	10,485	25.84	89.4	10.6	2.3	12.4	29.1	36.7	19.4
Risedronic acid	13,997	34.9	87.8	12.2	2.2	11.7	27.8	36.6	21.7
Total	40,003	100	88.2	11.8	2.3	11.6	27.8	36.8	21.5

Abbreviations: AODs, antiosteoporosis drugs; FDC, fixed dose combination; N, number.

Figure 1 Adherence to AODs by overall population.

Notes: Data are original and previously unpublished. Percentages are calculated as the number of adherent patients on the total cohort of naïve patients (N=40,003). *P<0.01: differences between periods are statistically significant.
Abbreviation: AODs, antiosteoporosis drugs.

Table 3 Adherence to first-line AODs

AOD	Adherence by drug
	6-month adherence		12-month adherence		36-month adherence
	N	%	N	%	N	%
Alendronic acid	8,029	51.7	6,855	44.2	4,952	31.9
Alendronic acid + colecalciferol (FDC)	5,826	55.6	5,005	47.7	3,540	33.8
Risedronic acid	7,836	56.0	6,715	48.0	4,880	34.9

Notes: Data are original and previously unpublished. Percentages of adherent patients are calculated as the number (N) of patients adherent to the drug on the total of patients who received the respective drug prescription (15,521 received alendronic acid, 10,485 FDC and 13,997 risedronic acid).

Abbreviations: AODs, antiosteoporosis drugs; FDC, fixed dose combination.

Table 4 Adherence to calcium and/or vitamin D supplements of patients treated with alendronic or risedronic acid

AODs supplements	Adherence by supplement
	6-month adherence			12-month adherence			36-month adherence
	n	%	N	n	%	N	n	%	N
Calciuma	213	14.3	1,488	144	8.2	1,755	76	3.0	2,533
Vitamin Db	3,916	62.0	6,319	3,711	50.2	7,393	2,632	23.2	11,344
Vitamin D + calciumb	2,088	20.4	10,216	1,334	12.0	11,075	653	5.0	13,030

Notes: Data are original and previously unpublished.

a Percentages of adherent patients are calculated on the total patients taking calcium supplements (N) in the cohort of naïve patients (40,003).

b Percentages of adherent patients are calculated on the total of vitamin D and vitamin D + calcium single supplements prescriptions (N), in the subcohort of naïve patients where FDC was excluded (29,518).

Abbreviations: AODs, antiosteoporosis drugs; FDC, fixed dose combination.

Table 5 Determinants of adherence

Variables	6-month adherence		12-month adherence		36-month adherence
	Na	OR, CI (95%)	Na	OR, CI (95%)	Na	OR, CI (95%)
Age
<50 years	359	–	300	–	218	–
50–59 years	2,483	1.70 (1.47–1.97)*	2,112	1.61 (1.39–1.88)*	1,526	1.47 (1.25–1.74)*
60–69 years	6,270	1.96 (1.70–2.25)*	5,466	1.95 (1.69–2.25)*	4,008	1.85 (1.58–2.17)*
70–79 years	8,161	1.95 (1.70–2.25)*	6,967	1.91 (1.66–2.21)*	5,068	1.88 (1.61–2.21)*
≥80 years	4,418	1.68 (1.46–1.94)*	3,730	1.66 (1.44–1.93)*	2,552	1.56 (1.33–1.85)*
Sex
Male	2,038	–	1,648	–	1,051	–
Female	19,653	1.64 (1.55–1.75)*	16,927	1.67 (1.57–1.79)*	12,321	1.81 (1.68–1.95)*
Concomitant therapies
Drugs for gastrointestinal diseases	16,083	1.16 (1.10–1.21)*	14,783	1.09 (1.03–1.15)**	12,050	0.93 (0.87–1.01)
Drugs for cardiovascular diseases	14,510	0.91 (0.87–0.95)*	12,988	0.87 (0.83–0.91)*	10,203	0.73 (0.69–0.77)*
Corticosteroids for systemic use, plain	4,135	1.16 (1.10–1.22)*	4,456	1.04 (1.00–1.10)	5,078	0.93 (0.89–0.97)**
Drugs for musculo-skeletal diseases	12,338	1.03 (0.98–1.07)	12,227	1.01 (0.97–1.05)	10,746	0.98 (0.92–1.03)
Drugs for nervous disorders	6,124	0.92 (0.88–0.97)**	6,311	0.90 (0.86–0.94)*	6,542	0.84 (0.80–0.88)*
Polytherapy (≥5 drugs)
Yes	14,651	0.94 (0.89–0.99)***	14,635	0.85 (0.80–0.91)*	12,493	0.63 (0.56–0.70)*
No	7,040	–	3,940	–	879	–

Notes:

a Number of adherent patients. Data are original and previously unpublished.

* P<0.001,

** P<0.01,

*** P<0.05. Multiple logistic regression analysis with odds ratio.

Abbreviations: CI, confidence interval; OR, odds ratio.