Therapeutic adherence to bisphosphonates.

Therapeutic adherence of patients is a key factor of treatment success in clinical praxis, although it is often neglected. Several studies have shown that insufficient persistence and compliance cause differences in the efficiency of treatments in clinical studies and clinical praxis. A recent meta-analysis even showed a clear inverse relationship between therapeutic adherence and mortality. Factors influencing the adherence to treatment include explanations by the physician, characteristics of the disease, patient's attitudes, but also the therapeutic regime. Osteoporosis as a chronic disorder with relatively long asymptomatic initial course represents a major problem. In addition, the currently available therapeutic regimes are discomfortable and, thus, contribute to the low therapeutic adherence of the patient. One of the factors causing discomfort in bisphosphonates therapy is the frequency of application--once daily or once weekly. Several questionnaire-based studies have shown that patients clearly prefer the new alternative once monthly regime available for ibandronate. Although the efficiency of the drug is proven in large clinical trials, the effects of the once monthly regime itself on hard clinical end-points like mortality can only be analyzed in long-term follow-up studies.