Abstract
BACKGROUND: Bisphosphonates are the mainstay drugs for osteoporosis, but in clinical practice, they are often ineffective due to low compliance. However, there have been few studies examining compliance on a product-by-product basis or in detail in Japan. This study aimed to clarify the bisphosphonate compliance from the viewpoints of product selection, formulation, and patient characteristics using medical insurance claim data in Japan, to generate useful knowledge for improving bisphosphonate compliance. METHODS: Bisphosphonate records for osteoporosis treatment were extracted from Japanese medical insurance claim data (2021-2023), and the Medication Possession Ratio (MPR) of each patient was calculated from the records. The calculated MPR and compliance classification (Compliant/Non-compliant/Dropout) based on dispensing status were statistically analyzed from viewpoints of drug product, dose form/frequency, and patient sex/age to investigate the influence of each factor on compliance. RESULTS: The mean MPR for all patients (N = 63,197) was 76.7%. Product choice influenced compliance, with significance in 230 pairs among the 71 major products. Tablet was the most compliant formulation, and compliance was better with longer dose intervals. Women showed significantly better compliance and older age was associated with better compliance. CONCLUSIONS: This study generated new data regarding product-specific MPRs, and clarified that product selection influences patient compliance. The study also supported previous findings that sex, age, and dose frequency influence compliance. It is expected that the findings of this study will be utilized for drug development, drug selection and patient guidance in clinical practice, to improve the treatment environment for osteoporosis.