Quality of Life Research

, Volume 23, Issue 7, pp 2109–2120 | Cite as

Validation of the Osteoporosis-Specific Morisky Medication Adherence Scale in long-term users of bisphosphonates

  • Kristi Reynolds
  • Hema N. Viswanathan
  • Paul Muntner
  • Teresa N. Harrison
  • T. Craig Cheetham
  • Jin-Wen Y. Hsu
  • Deborah T. Gold
  • Stuart Silverman
  • Andreas Grauer
  • Donald E. Morisky
  • Cynthia D. O’Malley



To examine the psychometric properties and validity of the 8-item Osteoporosis-Specific Morisky Medication Adherence Scale (OS-MMAS-8) in postmenopausal women prescribed bisphosphonates (BPs) for at least 15 months.


A random sample of women aged ≥55 years with osteoporosis prescribed daily or weekly BPs was identified. Pharmacy fill data were extracted to calculate the medication possession ratio (MPR). Eligible women were stratified by low (<0.50), medium (0.50–0.79), or high (≥0.80) MPR, with the a priori goal of recruiting 133 participants in each group. OS-MMAS-8 scores can range from 0 to 8 and were categorized as low (<6), medium (6 to <8), and high (8) adherence. Internal consistency reliability (Cronbach’s alpha), test–retest reliability [intraclass correlation coefficients (ICCs)] and convergent validity (correlating OS-MMAS-8 with MPR and other self-reported measures) were assessed.


A total of 400 women out of 449 respondents reported that they were still taking their BPs at the time of the survey and completed OS-MMAS-8. Overall, 38.5, 34.3, and 27.3 % of participants had low, medium, and high OS-MMAS-8 scores, respectively. The mean (SD) MPRs according to OS-MMAS-8 scores (<6, 6 to <8 and 8) were 56.9 (22.6), 69.0 (24.9), and 76.7 (26.4), respectively. The correlation between OS-MMAS-8 and MPR was 0.36; p < 0.0001. Cronbach’s alpha was 0.74, and the ICC was 0.83 (95 % CI 0.76–0.88).


OS-MMAS-8 has acceptable psychometric properties for assessing medication adherence in postmenopausal women prescribed therapy for osteoporosis. Additional studies are needed to investigate the psychometric properties of OS-MMAS-8 in other settings and populations.


Adherence Bisphosphonates Postmenopausal osteoporosis Psychometric Reliability Validity Morisky scale 



We acknowledge the exemplary contributions of the study staff at the Department of Research & Evaluation, Kaiser Permanente Southern California (Alexander Carruth, Kimberly Saylor, Rong Wei, and Sandra Zakai). We thank David Macarios of Amgen Inc. for his insights on the Needs–Concerns Differential analyses. This study was funded by a contractual agreement between Kaiser Permanente Southern California and Amgen Inc., Thousand Oaks, CA.

Conflict of interest

Drs. O’Malley, Viswanathan and Grauer are employees of Amgen Inc. and own stock in Amgen Inc. Drs. Muntner, Gold, Silverman, and Morisky have served as advisors for Amgen Inc. Drs. Muntner, Gold and Silverman have served as consultants for Amgen Inc. Drs. Reynolds and Muntner received research support from Amgen Inc. Dr. Silverman has served as an advisor for Lilly, Novartis and Pfizer/Wyeth. Dr. Silverman has served as a consultant for Genentech, Lilly, Novartis and Pfizer/Wyeth. Dr. Silverman has received research support from Lilly and Pfizer/Wyeth. This study was funded by a contractual agreement between Kaiser Permanente Southern California and Amgen Inc., Thousand Oaks, CA.

Supplementary material

11136_2014_662_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 16 kb)
11136_2014_662_MOESM2_ESM.docx (14 kb)
Supplementary material 2 (DOCX 14 kb)


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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Kristi Reynolds
    • 1
  • Hema N. Viswanathan
    • 2
  • Paul Muntner
    • 3
  • Teresa N. Harrison
    • 1
  • T. Craig Cheetham
    • 4
  • Jin-Wen Y. Hsu
    • 1
  • Deborah T. Gold
    • 5
    • 6
    • 7
  • Stuart Silverman
    • 8
  • Andreas Grauer
    • 9
  • Donald E. Morisky
    • 10
  • Cynthia D. O’Malley
    • 11
  1. 1.Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaUSA
  2. 2.Global Health EconomicsAmgen Inc.Thousand OaksUSA
  3. 3.Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Pharmacy Analytical ServiceKaiser PermanenteDowneyUSA
  5. 5.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  6. 6.Department of SociologyDuke University Medical CenterDurhamUSA
  7. 7.Department of Psychology and NeuroscienceDuke University Medical CenterDurhamUSA
  8. 8.Department of RheumatologyCedars-Sinai/UCLALos AngelesUSA
  9. 9.Clinical DevelopmentAmgen Inc.Thousand OaksUSA
  10. 10.Department of Community Health SciencesUCLA Fielding School of Public HealthLos AngelesUSA
  11. 11.Center for Observational ResearchAmgen Inc.South San FranciscoUSA

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