OBJECTIVES: Osteoporosis is a chronic global health condition, characterised by low bone density. Bisphosphonates are a common medication used to treat this condition. This study examined patient adherence and persistence with oral bisphosphonates for the treatment of osteoporosis.

METHODS: A systematic review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). MEDLINE, CINAHL, AMED, DARE, HTA and NHS EED databases were searched for studies published in English language up to 11th August 2017. We used a detailed list of search terms related to persistence and adherence of oral bisphosphonate treatment. In order to assess the quality of the studies we used the Newcastle – Ottawa quality assessment scale [NOS].

RESULTS: The search yielded 532 published studies, of which 89 were deemed relevant and were included in this review. The mean age of patients included within the studies ranged between 53 to 80.8 years, and the follow-up varied from 6 months to 14 years. The mean persistence of oral bisphosphonates for 6 months, 1 year and 2 years ranged from 38% to 79%, 12.6% to 77.6%, and 9.5% to 41.8%, respectively. The mean medication possession ratio (MPR), a measure of adherence, ranged from 58% to 92%. All the included studies scored the maximum applicable score of between 6 to 8 on the NOS. The determinants of adherence and persistence to oral bisphosphonates included geographic residence, marital status, tobacco use, educational status, income, race, hospitalisation and medication type and dosing frequency.

CONCLUSIONS: The findings of this review suggest that patients’ persistence with treatment was poor and dropped notably over the first two years. Overall, adherence was sub optimal. In order to maximize adherence and persistence to oral bisphosphonates it is important to consider their possible determinants including characteristics of the patients.