Assessment of osteoporosis medication adherence, quality oflife, and treatment satisfaction among women with osteoporosis:A cross-sectional study
Main Article Content
Keywords
Osteoporosis, Adherence, Quality of life, Medication-use, Lebanon
Abstract
Background: Osteoporosis is considered one of the most important postmenopausal problems. The absence of efficacy markers and intolerable side effects hinders treatment outcomes. This study aimed to assess adherence to medications, quality of life and treatment satisfaction among Lebanese osteoporotic women. Methods: This cross-sectional study was conducted between March-December 2020 in community and outpatient settings distributed in all Lebanese districts. A validated questionnaire was used to gather information through face-to-face and online interviews. Data was analyzed using a statistical package for social science (SPSS). Results: A total of 72 patients were recruited with a mean age of 60.40 of ± 8.86 years. Almost all women (94.40%) were menopause with a mean age of 48.97 ± 4.78 years (mean ± SD). The majority were married (83.30%), had 2 or more children (81.90%), and were educated (86.10%). The adherence score was positively and significantly associated with the duration of smoking (beta=0.22, CI=0.03-0.41, P-value=0.027) and calcium intake (beta=5.68, CI=1.56 - 9.80, p-value=0.009). On the other hand, a negative association was noted with vitamin D intake (beta=-15.34, CI=-27.95, -2.73, p-value=0.019). Conclusion: Treatment satisfaction was significantly associated with the participant’s age and menopause status. Proper education and awareness campaigns can help young women prevent the development of osteoporosis.
References
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45. Chakhtoura M, Leslie WD, McClung M, Cheung AM, Fuleihan GEH. The FRAX-based Lebanese osteoporosis treatment guidelines: rationale for a hybrid model. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2017 Jan;28(1):127–37.
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2. Saadeh R, Jumaa D, Elsalem L, Batieha A, Jaddou H, Khader Y, et al. Osteoporosis among Postmenopausal Women in Jordan: A National Cross-Sectional Study. Int J Environ Res Public Health. 2022 Jul 20;19(14):8803.
3. Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol. 2017 Mar;4(1):46–56.
4. Minkin MJ. Menopause: Hormones, Lifestyle, and Optimizing Aging. Obstet Gynecol Clin North Am. 2019 Sep;46(3):501–14.
5. Hyassat D, Alyan T, Jaddou H, Ajlouni KM. Prevalence and Risk Factors of Osteoporosis Among Jordanian Postmenopausal Women Attending the National Center for Diabetes, Endocrinology and Genetics in Jordan. BioResearch Open Access. 2017 Jul 1;6(1):85–93.
6. Garnero P, Sornay-Rendu E, Duboeuf F, Delmas PD. Markers of bone turnover predict postmenopausal forearm bone loss over 4 years: the OFELY study. J Bone Miner Res Off J Am Soc Bone Miner Res. 1999 Sep;14(9):1614–21.
7. Karlamangla AS, Burnett-Bowie SAM, Crandall CJ. Bone Health During the Menopause Transition and Beyond. Obstet Gynecol Clin North Am. 2018 Dec;45(4):695–708.
8. Johnell O. The socioeconomic burden of fractures: Today and in the 21st century. Am J Med. 1997 Aug 18;103(2):S20–6.
9. Karlsson C, Obrant KJ, Karlsson M. Pregnancy and lactation confer reversible bone loss in humans. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2001;12(10):828–34.
10. Lidfeldt J, Holmdahl L, Samsioe G, Nerbrand C, Nyberg P, Scherstén B, et al. The influence of hormonal status and features of the metabolic syndrome on bone density: a population-based study of Swedish women aged 50 to 59 years. The women’s health in the Lund area study. Metabolism. 2002 Feb;51(2):267–70.
11. Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehren LE, Abbott TA, et al. Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density in Postmenopausal Women: Results From the National Osteoporosis Risk Assessment. JAMA. 2001 Dec 12;286(22):2815.
12. Al-Daghri NM, Hussain SD, Alnaami AM, Aljohani N, Sabico S. Dietary Calcium Intake and Osteoporosis Risk in Arab Adults. Nutrients. 2023 Jun 21;15(13):2829.
13. Sunyecz JA. The use of calcium and vitamin D in the management of osteoporosis. Ther Clin Risk Manag. 2008 Aug;4(4):827–36.
14. Chapuy MC, Pamphile R, Paris E, Kempf C, Schlichting M, Arnaud S, et al. Combined calcium and vitamin D3 supplementation in elderly women: confirmation of reversal of secondary hyperparathyroidism and hip fracture risk: the Decalyos II study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2002 Mar;13(3):257–64.
15. Zahedirad M, Asadzadeh S, Nikooyeh B, Neyestani TR, Khorshidian N, Yousefi M, et al. Fortification aspects of vitamin D in dairy products: A review study. Int Dairy J. 2019 Jul 1;94:53–64.
16. Zhao JG, Zeng XT, Wang J, Liu L. Association Between Calcium or Vitamin D Supplementation and Fracture Incidence in Community-Dwelling Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017 Dec 26;318(24):2466–82.
17. Uusi-Rasi K, Patil R, Karinkanta S, Kannus P, Tokola K, Lamberg-Allardt C, et al. Exercise and vitamin D in fall prevention among older women: a randomized clinical trial. JAMA Intern Med. 2015 May;175(5):703–11.
18. Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause N Y N. 2021 Sep 1;28(9):973–97.
19. Yong EL, Logan S. Menopausal osteoporosis: screening, prevention and treatment. Singapore Med J. 2021 Apr;62(4):159–66.
20. Khosla S, Hofbauer LC. Osteoporosis treatment: recent developments and ongoing challenges. Lancet Diabetes Endocrinol. 2017 Nov;5(11):898–907.
21. Tosteson ANA, Grove MR, Hammond CS, Moncur MM, Ray GT, Hebert GM, et al. Early discontinuation of treatment for osteoporosis. Am J Med. 2003 Aug 15;115(3):209–16.
22. Pickney CS, Arnason JA. Correlation between patient recall of bone densitometry results and subsequent treatment adherence. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2005 Sep;16(9):1156–60.
23. Rossini M, Bianchi G, Di Munno O, Giannini S, Minisola S, Sinigaglia L, et al. Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2006;17(6):914–21.
24. Weiss M, Vered I, Foldes AJ, Cohen YC, Shamir-Elron Y, Ish-Shalom S, et al. Treatment preference and tolerability with alendronate once weekly over a 3-month period: an Israeli multi-center study. Aging Clin Exp Res. 2005 Apr;17(2):143–9.
25. Flood EM, Beusterien KM, Green H, Shikiar R, Baran RW, Amonkar MM, et al. Psychometric evaluation of the Osteoporosis Patient Treatment Satisfaction Questionnaire (OPSAT-Q), a novel measure to assess satisfaction with bisphosphonate treatment in postmenopausal women. Health Qual Life Outcomes. 2006 Jul 11;4:42.
26. Modi A, Ebeling PR, Lee MS, Min YK, Mithal A, Yang X, et al. Influence of gastrointestinal events on treatment of osteoporosis in Asia-Pacific women: Perspectives from physicians in the MUSIC OS-AP study. Bone Rep. 2017 Sep 20;7:108–13.
27. Weycker D, Lamerato L, Schooley S, Macarios D, Siu Woodworth T, Yurgin N, et al. Adherence with bisphosphonate therapy and change in bone mineral density among women with osteoporosis or osteopenia in clinical practice. Osteoporos Int. 2013 Apr;24(4):1483–9.
28. Oh KW, Kim DY, Lee YS, Kang MI, BRAVO (Osteoporosis and Bisphosphonates outcomes ReseArch Via questiOnnaire) Study Group. Osteoporosis Patient Treatment Satisfaction Questionnaire in postmenopausal women intermittently treated with oral bisphosphonates: the BRAVO study. J Bone Miner Metab. 2012 May;30(3):359–66.
29. Binkley N, Martens MG, Silverman SL, Derman RJ, Greenwald M, Kohles JD, et al. Improved GI tolerability with monthly ibandronate in women previously using weekly bisphosphonates. South Med J. 2009 May;102(5):486–92.
30. Ziller V, Zimmermann SP, Kalder M, Ziller M, Seker-Pektas B, Hellmeyer L, et al. Adherence and persistence in patients with severe osteoporosis treated with teriparatide. Curr Med Res Opin. 2010 Mar;26(3):675–81.
31. Cramer JA, Gold DT, Silverman SL, Lewiecki EM. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2007 Aug;18(8):1023– 31.
32. Kothawala P, Badamgarav E, Ryu S, Miller RM, Halbert RJ. Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] [Internet]. Centre for Reviews and Dissemination (UK); 2007 [cited 2024 Feb 21].
33. McHorney CA, Schousboe JT, Cline RR, Weiss TW. The impact of osteoporosis medication beliefs and side-effect experiences on non-adherence to oral bisphosphonates. Curr Med Res Opin. 2007 Dec;23(12):3137–52.
34. Silverman S, Gold DT. Medication Decision-making in Osteoporosis: Can We Explain Why Patients Do Not Take Their Osteoporosis Medications? Curr Osteoporos Rep. 2018 Dec;16(6):772–4.
35. Akarırmak Ü, Koçyiğit H, Eskiyurt N, Esmaeilzadeh S, Kuru Ö, Yalçinkaya EY, et al. Influence of patient training on persistence, compliance, and tolerability of different dosing frequency regimens of bisphosphonate therapy: An observational study in Turkish patients with postmenopausal osteoporosis. Acta Orthop Traumatol Turc. 2016 Aug;50(4):415–23.
36. Elaine L, Papaioannou A, Dolovich L, Adachi J, Sawka AM, Burns S, et al. Patients’ adherence to osteoporosis therapy. Can Fam Physician. 2008 Mar;54(3):394–402.
37. Hadji P, Claus V, Ziller V, Intorcia M, Kostev K, Steinle T. GRAND: the German retrospective cohort analysis on compliance and persistence and the associated risk of fractures in osteoporotic women treated with oral bisphosphonates. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2012 Jan;23(1):223–31.
38. Weycker D, Macarios D, Edelsberg J, Oster G. Compliance with drug therapy for postmenopausal osteoporosis. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2006;17(11):1645–52.
39. Cotté FE, Fardellone P, Mercier F, Gaudin AF, Roux C. Adherence to monthly and weekly oral bisphosphonates in women with osteoporosis. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2010 Jan;21(1):145–55.
40. Hopman WM, Berger C, Joseph L, Morin SN, Towheed T, Anastassiades T, et al. Longitudinal assessment of health-related quality of life in osteoporosis: data from the population-based Canadian Multicentre Osteoporosis Study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2019 Aug;30(8):1635–44.
41. Papaioannou A, Kennedy CC, Ioannidis G, Sawka A, Hopman WM, Pickard L, et al. The impact of incident fractures on health- related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2009 May;20(5):703–14.
42. Guillemin F, Martinez L, Calvert M, Cooper C, Ganiats T, Gitlin M, et al. Fear of falling, fracture history, and comorbidities are associated with health-related quality of life among European and US women with osteoporosis in a large international study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2013 Dec;24(12):3001–10.
43. Kwon HY, Ha YC, Yoo JI. Health-related Quality of Life in Accordance with Fracture History and Comorbidities in Korean Patients with Osteoporosis. J Bone Metab. 2016 Nov;23(4):199–206.
44. Ahmadieh H, Basho A, Chehade A, Al Mallah A, Dakour A. Perception of peri-menopausal and postmenopausal Lebanese women on osteoporosis: A cross-sectional study. J Clin Transl Endocrinol. 2018 Oct 3;14:19–24.
45. Chakhtoura M, Leslie WD, McClung M, Cheung AM, Fuleihan GEH. The FRAX-based Lebanese osteoporosis treatment guidelines: rationale for a hybrid model. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2017 Jan;28(1):127–37.
46. Maalouf G, Salem S, Sandid M, Attallah P, Eid J, Saliba N, et al. Bone mineral density of the Lebanese reference population. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2000;11(9):756–64.
47. Hill CD, Fehnel SE, Bobula JD, Yu H, McLeod LD. Development and preliminary validation of the Menopause Symptoms Treatment Satisfaction Questionnaire (MS-TSQ). Menopause N Y N. 2007;14(6):1047–55.
48. Avenell A, Mak JCS, O’Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014 Apr 14;2014(4):CD000227.
49. Cesareo R, Iozzino M, D’onofrio L, Terrinoni I, Maddaloni E, Casini A, et al. Effectiveness and safety of calcium and vitamin D treatment for postmenopausal osteoporosis. Minerva Endocrinol. 2015 Sep;40(3):231–7.
50. Francis RM. Non-response to osteoporosis treatment. J Br Menopause Soc. 2004 Jun;10(2):76–80.
51. Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2016 Jan;27(1):367–76.
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Jun 20, 2026
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Assessment of osteoporosis medication adherence, quality oflife, and treatment satisfaction among women with osteoporosis:A cross-sectional study. Pharm Pract (Granada) [Internet]. 2026 Jun. 20 [cited 2026 Jun. 21];24(2):1-10. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3387
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How to Cite
1.
Assessment of osteoporosis medication adherence, quality oflife, and treatment satisfaction among women with osteoporosis:A cross-sectional study. Pharm Pract (Granada) [Internet]. 2026 Jun. 20 [cited 2026 Jun. 21];24(2):1-10. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/3387