Drugs & Aging

, Volume 24, Issue 1, pp 37–55 | Cite as

Patient Adherence to Osteoporosis Medications

Problems, Consequences and Management Strategies
  • Alexandra Papaioannou
  • Courtney C. Kennedy
  • Lisa Dolovich
  • Elaine Lau
  • Jonathan D. Adachi
Review Article


Adherence to osteoporosis medications is relatively poor. Approximately 20–30% of patients taking daily or weekly treatments may suspend their treatment within 6 to 12 months of initiating therapy. Patients with poor adherence increase their risk of osteoporotic fractures and hospitalisation. The majority of patients who discontinue therapy appear to do so because of drug-induced adverse effects. Fear of adverse effects or other health risks is another commonly cited reason for discontinuing therapy. Factors associated with medication adherence include fractures, regular exercise, female sex, fewer non-osteoporosis medications and co-morbidities, early menopause, willingness to take medications, awareness of osteoporosis status based on a diagnostic test, anti-inflammatory therapy and corticosteroid therapy. Factors associated with non-adherence include adverse effects, pain and being unsure about bone mineral density (BMD) test results. Bisphosphonates, a common class of drugs for treating osteoporosis, have specific administration requirements (e.g. fasting, remaining upright and not ingesting other medications concomitantly). Patient surveys indicate that 12–18% of patients report non-compliance with at least one administration rule. Strategies to increase adherence include reducing administration frequency to weekly or monthly, monitoring patients with bone markers and BMD testing, providing adequate instructions, practitioner feedback and support, and educational materials and sessions. Future studies are needed regarding strategies to increase adherence to osteoporosis medications.


Bone Mineral Density Osteoporosis Hormone Replacement Therapy Raloxifene Strontium Ranelate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



JD Adachi has acted as a consultant for and/or received honoraria from Amgen, Astra Zeneca, sanofi-aventis, Eli Lilly, GlaxoSmithKline, Merck, Novartis, NPS Allelix, Pfizer, Procter & Gamble, Roche, Servier, Wyeth.

Alexandra Papaioannou has acted as a consultant and received honoraria or grants from Eli Lilly, Merck Frosst Canada, Procter & Gamble Pharmaceuticals Canada and sanofi-aventis, and has acted as a consultant and received honoraria from Novartis.

Courtney Kennedy, Lisa Dolovich and Elaine Lau have no potential conflicts of interest of direct relevance to the content of this review.

No sources of funding were used to assist in the preparation of this review.


  1. 1.
    Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med 1991; 90(1): 107–110Google Scholar
  2. 2.
    Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis. Osteoporos Int 1999; 10(4): 259–64PubMedCrossRefGoogle Scholar
  3. 3.
    Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int 2005; 16Suppl. 2: S3–7PubMedCrossRefGoogle Scholar
  4. 4.
    Kanis JA, Johnell O, De Laet C, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone 2004; 35(2): 375–82PubMedCrossRefGoogle Scholar
  5. 5.
    Adachi JD, Olszynski WP, Hanley DA, et al. Management of corticosteroid-induced osteoporosis. Semin Arthritis Rheum 2000; 29(4): 228–51PubMedCrossRefGoogle Scholar
  6. 6.
    Kanis JA, Johansson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res 2004; 19(6): 893–9PubMedCrossRefGoogle Scholar
  7. 7.
    Kanis JA, Johnell O, Oden A, et al. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 2001; 12(12): 989–95PubMedCrossRefGoogle Scholar
  8. 8.
    Johnell O, Kanis JA, Oden A, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res 2005; 20(7): 1185–94PubMedCrossRefGoogle Scholar
  9. 9.
    Kanis JA, Johansson H, Oden A, et al. A family history of fracture and fracture risk: a meta-analysis. Bone 2004; 35(5): 1029–37PubMedCrossRefGoogle Scholar
  10. 10.
    Ray NF, Chan JK, Thamer M, et al. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997; 12(1): 24–35PubMedCrossRefGoogle Scholar
  11. 11.
    Ross PD. Osteoporosis: frequency, consequences, and risk factors. Arch Intern Med 1996; 156(13): 1399–411PubMedCrossRefGoogle Scholar
  12. 12.
    Chrischilles EA, Butler CD, Davis CS, et al. A model of lifetime osteoporosis impact. Arch Intern Med 1991; 151(10): 2026–32PubMedCrossRefGoogle Scholar
  13. 13.
    National Osteoporosis Foundation. America’s bone health: the state of osteoporosis and low bone mass in our nation. Washington, DC: National Osteoporosis Foundation, 2002Google Scholar
  14. 14.
    Cranney A, Guyatt G, Griffith L, et al. Meta-analyses of therapies for postmenopausal osteoporosis: IX. Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 2002; 23(4): 570–8PubMedCrossRefGoogle Scholar
  15. 15.
    Sawka AM, Papaioannou A, Adachi JD, et al. Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women. BMC Musculoskelet Disord 2005; 6: 39PubMedCrossRefGoogle Scholar
  16. 16.
    Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353(5): 487–97PubMedCrossRefGoogle Scholar
  17. 17.
    Sackett DL. Introduction. In: Sackett DL, editor. Compliance with therapeutic regimens. Baltimore MD): Johns Hopkins University Press, 1976Google Scholar
  18. 18.
    Haynes RB, Yao X, Degani A, et al. Interventions to enhance medication adherence. Cochrane Database Syst Rev 2005; 4: CD000011Google Scholar
  19. 19.
    Peterson AM, Takiya L, Finley R. Meta-analysis of trials of interventions to improve medication adherence. Am J Health Syst Pharm 2003; 60(7): 657–65PubMedGoogle Scholar
  20. 20.
    Cranney A, Tugwell P, Wells G, et al. Meta-analyses of therapies for postmenopausal osteoporosis: I. Systematic reviews of randomized trials in osteoporosis: introduction and methodology. Endocr Rev 2002; 23(4): 496–507PubMedCrossRefGoogle Scholar
  21. 21.
    Cranney A, Tugwell P, Adachi J, et al. Meta-analyses of therapies for postmenopausal osteoporosis: III. Meta-analysis of risedronate for the treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23(4): 517–23PubMedCrossRefGoogle Scholar
  22. 22.
    Cranney A, Wells G, Willan A, et al. Meta-analyses of therapies for postmenopausal osteoporosis: II. Meta-analysis of alendronate for the treatment of postmenopausal women. Endocr Rev 2002; 23(4): 508–16PubMedCrossRefGoogle Scholar
  23. 23.
    Cranney A, Guyatt G, Krolicki N, et al. A meta-analysis of etidronate for the treatment of postmenopausal osteoporosis. Osteoporos Int 2001; 12(2): 140–51PubMedCrossRefGoogle Scholar
  24. 24.
    Cranney A, Tugwell P, Zytaruk N, et al. Meta-analyses of therapies for postmenopausal osteoporosis: IV. Meta-analysis of raloxifene for the prevention and treatment of postmenopausal osteoporosis. Endocr Rev 2002; 23(4): 524–8PubMedCrossRefGoogle Scholar
  25. 25.
    Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288(3): 321–33PubMedCrossRefGoogle Scholar
  26. 26.
    Cranney A, Wells GA. Hormone replacement therapy for postmenopausal osteoporosis. Clin Geriatr Med 2003; 19(2): 361–70PubMedCrossRefGoogle Scholar
  27. 27.
    Caro JJ, Ishak KJ, Huybrechts KF, et al. The impact of compliance with osteoporosis therapy on fracture rates in actual practice. Osteoporos Int 2004; 15(12): 1003–8PubMedCrossRefGoogle Scholar
  28. 28.
    Goettsch WG, Penning F, Erkens JE, et al. Persistent bisphosphonate usage reduces the risk of hospitalizations for osteoporotic fractures [abstract]. J Bone Miner Res 2005; 20Suppl. 1: S278Google Scholar
  29. 29.
    Weycker D, Macarios D, Oster G. Adherence with drug therapy and risk of fracture among women with postmenopausal osteoporosis [abstract]. J Bone Miner Res 2005; 20Suppl. 1: S383Google Scholar
  30. 30.
    Huybrechts KF, Ishak KJ, Caro JJ. Assessment of compliance with osteoporosis treatment and its consequences in a managed care population. Bone 2005; 38(6): 922–8PubMedCrossRefGoogle Scholar
  31. 31.
    Eastell R, Garnero P, Vrijens B, et al. Influence of patient compliance with risedronate therapy on bone turnover marker and bone mineral density response: the IMPACT study [abstract]. Calcif Tissue Int 2003, 72Google Scholar
  32. 32.
    Yood RA, Emani S, Reed JI, et al. Compliance with pharmacologie therapy for osteoporosis. Osteoporos Int 2003; 14(12): 965–8PubMedCrossRefGoogle Scholar
  33. 33.
    Reginster J, Minne HW, Sorensen OH, et al. Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 2000; 11(1): 83–91PubMedCrossRefGoogle Scholar
  34. 34.
    Black DM, Cummings SR, Karpf DB, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 1996; 348(9041): 1535–41PubMedCrossRefGoogle Scholar
  35. 35.
    Liberman UA, Weiss SR, Broll J, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995; 333(22): 1437–43PubMedCrossRefGoogle Scholar
  36. 36.
    Ho AY, Kung AW. Efficacy and tolerability of alendronate once weekly in Asian postmenopausal osteoporotic women. Ann Pharmacother 2005; 39(9): 1428–33PubMedCrossRefGoogle Scholar
  37. 37.
    Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) investigators. JAMA 1999; 282(7): 637–45PubMedCrossRefGoogle Scholar
  38. 38.
    Grady D, Herrington D, Bittner V, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002; 288(1): 49–57PubMedCrossRefGoogle Scholar
  39. 39.
    Haynes RB, McKibbon KA, Kanani R. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications. Lancet 1996; 348(9024): 383–6PubMedCrossRefGoogle Scholar
  40. 40.
    Haynes RB, Dantes R. Patient compliance and the conduct and interpretation of therapeutic trials. Control Clin Trials 1987; 8(1): 12–9PubMedCrossRefGoogle Scholar
  41. 41.
    Tosteson AN, Grove MR, Hammond CS, et al. Early discontinuation of treatment for osteoporosis. Am J Med 2003; 115(3): 209–16PubMedCrossRefGoogle Scholar
  42. 42.
    Hamilton B, McCoy K, Taggart H. Tolerability and compliance with risedronate in clinical practice. Osteoporos Int 2003; 14(3): 259–62PubMedGoogle Scholar
  43. 43.
    Segal E, Tamir A, Ish-Shalom S. Compliance of osteoporotic patients with different treatment regimens. Isr Med Assoc J 2003; 5(12): 859–62PubMedGoogle Scholar
  44. 44.
    Rossini M, Bianchi G, Di Munno O, et al. Determinants of adherence to osteoporosis treatment in clinical practice. Osteoporos Int 2006; 17(6): 914–21PubMedCrossRefGoogle Scholar
  45. 45.
    Zanchetta J, Hakim C, Lombas C. Observational study of compliance and continuance rates of raloxifene in the prevention and treatment of osteoporosis. Current Therapeutic Research 2004; 6: 470–80CrossRefGoogle Scholar
  46. 46.
    Papaioannou A, Ioannidis G, Adachi JD, et al. Adherence to bisphosphonates and hormone replacement therapy in a tertiary care setting of patients in the CANDOO database. Osteoporos Int 2003; 14(10): 808–13PubMedCrossRefGoogle Scholar
  47. 47.
    Steel SA, Albertazzi P, Howarth EM, et al. Factors affecting long-term adherence to hormone replacement therapy after screening for osteoporosis. Climacteric 2003; 6(2): 96–103PubMedGoogle Scholar
  48. 48.
    Ettinger B, Pressman A, Schein J, et al. Alendronate use among 812 women: prevalence of gastrointestinal complaints, non-compliance with patient instructions, and discontinuation. J Managed Care Pharm 1998; 4(5): 488–92Google Scholar
  49. 49.
    Turbi C, Herrero-Beaumont G, Acebes JC, et al. Compliance and satisfaction with raloxifene versus alendronate for the treatment of postmenopausal osteoporosis in clinical practice: an open-label, prospective, nonrandomized, observational study. Clin Ther 2004; 26(2): 245–56PubMedCrossRefGoogle Scholar
  50. 50.
    Carnevale V, Nieddu L, Romagnoli E, et al. Osteoporosis intervention in ambulatory patients with previous hip fracture: a multicentric, nationwide Italian survey. Osteoporos Int 2005; 17(3): 478–83PubMedCrossRefGoogle Scholar
  51. 51.
    Cramer JA, Amonkar MM, Hebborn A, et al. Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 2005; 21(9): 1453–60PubMedCrossRefGoogle Scholar
  52. 52.
    McCombs JS, Thiebaud P, McLaughlin-Miley C, et al. Compliance with drug therapies for the treatment and prevention of osteoporosis. Maturitas 2004; 48(3): 271–87PubMedCrossRefGoogle Scholar
  53. 53.
    Brown JP, Josse RG. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002; 167 (10 Suppl.): Sl–34Google Scholar
  54. 54.
    Eli Lilly and Company. About taking EVISTA [online]. Available from URL: [Accessed 2006 Mar 16]
  55. 55.
    Aki S, Eskiyurt N, Akarirmak U, et al. Gastrointestinal side effect profile due to the use of alendronate in the treatment of osteoporosis. Yonsei Med J 2003; 44(6): 961–7PubMedGoogle Scholar
  56. 56.
    Lombas C, Hakim C, Zanchetta J. Compliance with alendronate treatment in an osteoporosis clinic [abstract]. J Bone Miner Res 2001; 15: S529Google Scholar
  57. 57.
    Ettinger B, Pressman A, Silver P. Effect of age on reasons for initiation and discontinuation of hormone replacement therapy. Menopause 1999; 6(4): 282–9PubMedCrossRefGoogle Scholar
  58. 58.
    den Tonkelaar I, Oddens BJ. Determinants of long-term hormone replacement therapy and reasons for early discontinuation. Obstet Gynecol 2000; 95(4): 507–12CrossRefGoogle Scholar
  59. 59.
    Solomon DH, Avorn J, Katz JN, et al. Compliance with osteoporosis medications. Arch Intern Med 2005; 165(20): 2414–9PubMedCrossRefGoogle Scholar
  60. 60.
    Recker RR, Gallagher R, MacCosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005; 80(7): 856–61PubMedCrossRefGoogle Scholar
  61. 61.
    Miller PD, Woodson G, Licata AA, et al. Rechallenge of patients who had discontinued alendronate therapy because of upper gastrointestinal symptoms. Clin Ther 2000 Dec; 22(12): 1433–42PubMedCrossRefGoogle Scholar
  62. 62.
    Rizzoli R, Greenspan SL, Bone G, et al. Two-year results of once-weekly administration of alendronate 70mg for the treatment of postmenopausal osteoporosis. J Bone Miner Res 2002; 17(11): 1988–96PubMedCrossRefGoogle Scholar
  63. 63.
    Rizzoli R. Long-term outcome of weekly bisphosphonates. Clin Orthop Relat Res 2006; 443: 61–5PubMedCrossRefGoogle Scholar
  64. 64.
    Watts NB, Lindsay R, Li Z, et al. Use of matched historical controls to evaluate the anti-fracture efficacy of once-a-week risedronate. Osteoporos Int 2003; 14(5): 437–41PubMedCrossRefGoogle Scholar
  65. 65.
    Kendler D, Kung AW, Fuleihan G, et al. Patients with osteoporosis prefer once weekly to once daily dosing with alendronate. Maturitas 2004; 48(3): 243–51PubMedCrossRefGoogle Scholar
  66. 66.
    Weiss M, Vered I, Foldes AJ, 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; 17(2): 143–9PubMedGoogle Scholar
  67. 67.
    Simon JA, Lewiecki EM, Smith ME, et al. Patient preference for once-weekly alendronate 70mg versus once-daily alendronate 10 mg: a multicenter, randomized, open-label, crossover study. Clin Ther 2002; 24(11): 1871–86PubMedCrossRefGoogle Scholar
  68. 68.
    Roche. FDA approves once-monthly Boniva for osteoporosis [online]. Available from URL: [Accessed 2006 Oct 23]
  69. 69.
    Reginster JY, Adami S, Lakatos P, et al. Efficacy and tolerability of once-monthly oral ibandronate in postmenopausal osteoporosis: 2 year results from the MOBILE study. Ann Rheum Dis 2006 May; 65(5): 654–61PubMedCrossRefGoogle Scholar
  70. 70.
    Chesnut CH, Ettinger MP, Miller PD, et al. Ibandronate produces significant, similar antifracture efficacy in North American and European women: new clinical findings from BONE. Curr Med Res Opin 2005; 21(3): 391–401PubMedCrossRefGoogle Scholar
  71. 71.
    Reginster JY, Rabenda V, Neuprez A. Adherence, patient preference and dosing frequency: understanding the relationship. Bone 2006; 38 (4 Suppl. 1): S2–6PubMedCrossRefGoogle Scholar
  72. 72.
    Emkey R. BNSLRC. BALTO I: women treated for osteoporosis rate preference and convenience for once-monthly ibandronate versus once-weekly alendronate [abstract]. J Bone Miner Res 2005; 20Suppl. 1: S416Google Scholar
  73. 73.
    Blalock SJ, DeVellis BM, Patterson CC, et al. Effects of an osteoporosis prevention program incorporating tailored educational materials. Am J Health Promot 2002; 16(3): 146–56PubMedCrossRefGoogle Scholar
  74. 74.
    Chapurlat RD, Cummings SR. Does follow-up of osteoporotic women treated with antiresorptive therapies improve effectiveness? Osteoporos Int 2002; 13(9): 738–44PubMedCrossRefGoogle Scholar
  75. 75.
    Clowes JA, Peel NF, Eastell R. The impact of monitoring on adherence and persistence with antiresorptive treatment for postmenopausal osteoporosis: a randomized controlled trial. J Clin Endocrinol Metab 2004; 89(3): 1117–23PubMedCrossRefGoogle Scholar
  76. 76.
    Rijcken CA, Tobi H, Vergouwen AC, et al. Refill rate of antipsychotic drugs: an easy and inexpensive method to monitor patients’ compliance by using computerised pharmacy data. Pharmacoepidemiol Drug Saf 2004; 13(6): 365–70PubMedCrossRefGoogle Scholar
  77. 77.
    Pilon D, Castilloux AM, LeLorier J. Estrogen replacement therapy: determinants of persistence with treatment. Obstet Gynecol 2001; 97(1): 97–100PubMedCrossRefGoogle Scholar
  78. 78.
    Morgan SG, Yan L. Persistence with hypertension treatment among community-dwelling BC seniors. Can J Clin Pharmacol 2004; 11(2): e267–73PubMedGoogle Scholar
  79. 79.
    Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288(4): 462–7PubMedCrossRefGoogle Scholar
  80. 80.
    Haynes RB, Taylor DW, Sackett DL, et al. Can simple clinical measurements detect patient noncompliance? Hypertension 1980; 2(6): 757–64PubMedCrossRefGoogle Scholar
  81. 81.
    Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24(1): 67–74PubMedCrossRefGoogle Scholar
  82. 82.
    Royal Pharmaceutical Society of Great Britain. From compliance to concordance: towards shared goals in medicine taking. London: Royal Pharmaceutical Society of Great Britain, 1997Google Scholar
  83. 83.
    MacLaughlin EJ, MacLaughlin AA, Snella KA, et al. Osteoporosis screening and education in community pharmacies using a team approach. Pharmacotherapy 2005; 25(3): 379–86PubMedCrossRefGoogle Scholar
  84. 84.
    Elliott ME, Meek PD, Kanous NL, et al. Pharmacy-based bone mass measurement to assess osteoporosis risk. Ann Pharmacother 2002; 36(4): 571–7PubMedCrossRefGoogle Scholar
  85. 85.
    Dawson-Hughes B, Harris SS, Krall EA, et al. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997; 337(10): 670–6PubMedCrossRefGoogle Scholar
  86. 86.
    Jackson RD, LaCroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006; 354(7): 669–83PubMedCrossRefGoogle Scholar
  87. 87.
    Larsen ER, Mosekilde L, Foldspang A. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. J Bone Miner Res 2004; 19(3): 370–8PubMedCrossRefGoogle Scholar
  88. 88.
    Porthouse J, Cockayne S, King C, et al. Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005; 330(7498): 1003PubMedCrossRefGoogle Scholar
  89. 89.
    Prince RL, Devine A, Dhaliwal SS, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med 2006; 166(8): 869–75PubMedCrossRefGoogle Scholar
  90. 90.
    Mastaglia SR, Pellegrini GG, Mandalunis PM, et al. Vitamin D insufficiency reduces the protective effect of bisphosphonate on ovariectomy-induced bone loss in rats. Bone 2006; 39(4): 837–44PubMedCrossRefGoogle Scholar
  91. 91.
    Koster JC, Hackeng WH, Mulder H. Diminished effect of etidronate in vitamin D deficient osteopenic postmenopausal women. Eur J Clin Pharmacol 1996; 51(2): 145–7PubMedCrossRefGoogle Scholar
  92. 92.
    French MR, Moore K, Vernace-Inserra F, et al. Factors that influence adherence to calcium recommendations. Can J Diet Pract Res 2005; 66(1): 25–9PubMedCrossRefGoogle Scholar
  93. 93.
    Feldstein A, Elmer PJ, Orwoll E, et al. Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation. Arch Intern Med 2003; 163(18): 2165–72PubMedCrossRefGoogle Scholar
  94. 94.
    Papaioannou A, Giangregorio L, Kvern B, et al. The osteoporosis care gap in Canada. BMC Musculoskelet Disord 2004; 5: 11PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Alexandra Papaioannou
    • 1
    • 2
  • Courtney C. Kennedy
    • 1
  • Lisa Dolovich
    • 1
    • 2
    • 3
  • Elaine Lau
    • 2
    • 3
  • Jonathan D. Adachi
    • 1
  1. 1.Department of MedicineMcMaster UniversityHamiltonCanada
  2. 2.The Team for Individualizing Pharmacotherapy in Primary Care for Senior (TIPPS)HamiltonCanada
  3. 3.Centre For Evaluation of MedicinesSt Joseph’s Healthcare Hamilton and McMaster University, Faculty of Health SciencesHamiltonCanada

Personalised recommendations