NETKING

By Frederik JoelvingNEW YORK | Mon Feb 27, 2012 5:27pm EST(Reuters Health) - People with the bone-thinning condition osteoporosis often skip the drugs they are prescribed, and telephone counseling does little to change that, according to new research.
Researchers said osteoporosis is involved in more than two million fractures a year in the U.S., racking up medical costs of $19 billion.
In addition to exercise and a healthy diet with enough calcium and vitamin D, as well as measures to prevent falls, medications may reduce the risk of broken bones -- which can take a serious toll on the health of old people.
For people at high risk, bone drugs such as bisphosphonates may cut the yearly fracture risk from five percent to three percent, said Dr. Daniel Solomon of Brigham and Women's Hospital in Boston.
But people often stop taking the medications, added Solomon, also of Harvard Medical School.
"It's the problem with all chronic conditions," he told Reuters Health. "Drugs for asymptomatic chronic conditions are universally poorly adhered to."
Some 10 million Americans currently suffer from bone thinning, according to the National Osteoporosis Foundation. The majority are postmenopausal women.
Bone drugs include Merck's Fosamax, Roche's Boniva, Novartis's Reclast and Warner Chilcott's Actonel.
To see if they could convince people to take their drugs, Solomon and his colleagues divided more than 2,000 men and women with osteoporosis into two groups.
The participants were all on Medicare, the government's health insurance for the elderly, and got their meds for a co-pay of no more than a few dollars.
All of them received fall-prevention lifestyle tips in the mail from the researchers, and one group also had about eight counseling sessions over the phone.
During those sessions, trained counselors tried to identify why people skipped their drugs and to motivate them to get back on the treatment. The intervention ended up costing about $281 per patient, including training of the counselors.
After one year, there was little difference between the two groups.
Those who got counseling filled their prescriptions 49 percent of the time, while the others did so 41 percent of the time, based on claims data. That gap was too small to be reliable, statistically speaking.
The researchers didn't find any differences in how many people broke a bone or reported falls, either.
According to Solomon, people who skipped their medicine often said they had forgotten about it, didn't like the way it made them feel or didn't think they needed it.
Still, Solomon, whose findings appear in the Archives of Internal Medicine, wasn't willing to give up on counseling.
"It would be overstating the data to say that we should use this. What I'm saying is you don't want to throw the baby out with the bathwater," he said. "I think that counseling is something we need to continue to examine."
Researchers have been experimenting with a lot of ways to get people to take their drugs, including beeping pill caps and financial incentives, Solomon added. But the results have often been disappointing.
"At this point there really aren't any proven interventions," he said.
In an editorial, Dr. Seth Berkowitz and Dr. Kirsten Johansen of the University of California, San Francisco, say behavior change is an increasingly important part of medicine as chronic diseases continue rise.
"There is likely no 'magic bullet' in the behavior change arsenal in general or for increasing treatment adherence specifically," they write. "This does not mean, however, that the effects may not be clinically significant."
SOURCE: bit.ly/yMrnv4 Archives of Internal Medicine, February 27, 2012.