In randomised clinical trials, these treatments can reduce fracture incidence by up to 50%. However, in routine care, these see more treatment benefits may be compromised by poor

adherence to treatment, with around 50% of women discontinuing treatment within 1 year [10, 11]. Suboptimal adherence to antiresorptive treatment has been shown to be associated with an increased risk of fracture [12–14]. Barriers to better adherence to osteoporosis treatment include the constraints associated with the administration of some of these agents, side-effects, the treatment regimen, the lack of a visible “read-out” of treatment benefit and inappropriate patient expectations and perceptions [15–17].

Improving RepSox adherence to osteoporosis treatment thus represents an important public health issue. Achieving this requires appropriate tools to measure adherence which KU-57788 order can be used to monitor improvements due to public health interventions. The notion of adherence involves a number of inter-related aspects. With regard to osteoporosis, an expert consensus recently described adherence as a general term encompassing both compliance and persistence [18]. Compliance was defined as the extent to which a patient acts in accordance with the prescribed interval and dose of a given treatment regimen, whereas persistence was defined as the cumulative time from initiation to discontinuation of therapy. Currently, three principal types of adherence measure have been developed, prescription follow-up or pharmacy claims to determine medication consumption over time, direct medication use measures (for example, pill counts, electronic measures or canister weights) or patient reports. Direct medication use measures are not particularly useful for naturalistic studies, since they may lead to bias due to potential

modification of adherence behaviour by implementation of the reporting measure. Of the prescription follow-up methods, the medication possession ratio (MPR) [19, 20] has Gemcitabine manufacturer been widely used. A number of patient-reported measures of treatment adherence have been developed and validated, including the Morisky Medication Adherence Scale (MMAS) [21], the Medication Adherence Report Scale [22], the Adherence to Refills and Medications Scale [23], the ASK-20 [24] and the Hypertension Compliance Questionnaire [25]. However, none of these instruments were designed specifically with osteoporosis in mind, and it would therefore be of interest to develop a disease-specific adherence measure which would focus on adherence issues that are pertinent to osteoporosis and its treatment and may be more discriminating and sensitive to change than non-specific measures.