The impact of shared-decision-making on persistence in Osteoporosis-Therapy

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. medications stop taking them. In the process of shared-decision-making (SDM), patients decide together with their physician about their medication. Studies in other common chronic diseases showed that this partnership improves persistence and compliance. This project investigates whether this effect exists also in osteoporosis.

Methods: 79 patients (age 35 to 89, mean 67yrs) were analyzed retrospectively, comparing their first year of conventionally prescribed osteoporosis-therapy in previous institutions and their first year with therapy after SDM. 67,1% (n = 53) of patients had one or more former fractures. The rates of persistence, reasons for therapy discontinuation and change of medication were compared.

Results: 82,3% (n = 65) of patients had been persistent in the first external therapy year (n = 79), 6,3% (n = 5) had changed the medication and 11,4% (n = 9) had discontinued therapy during this year. In the following clinical course (external time until admission to IOZ, mean 48 months, maximum 237 months) further 12 patients of the initially 65 persistent patients discontinued their therapy and 10 had a change of therapy. At IOZ admission 62 patients were on therapy, 17 were not. After SDM, in the first IOZ therapy year 52 (65,8%) of the 79 patients were persistent.17 (21,5%) had a change of therapy and 10 (12,7%) discontinued their therapy. Altogether, side effects were responsible for 44,4% (n = 12) of change or discontinuation of therapy.

Conclusion: Persistence with a single drug regimen after SDM (65,8%) was lower than before (82,3%). After SDM more patients changed their medication (6,3% vs. 21,5%). Through managing side effects, the rate of patients remaining on any specific osteoporosis therapy was 87% after one year after SDM.