Alendronate Use Among 812 Women: Prevalence of Gastrointestinal Complaints, Noncompliance with Patient Instructions, and Discontinuation

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Abstract
The objective of this study was to determine the extent to which women who receive alendronate therapy for osteoporosis comply with instructions regarding its use, find alendronate tolerable, and continue with the treatment. Through telephone interview surveys and retrospective database analysis, the authors surveyed 812 women with a mean (SO) age of 68.7 (11.7) years, who filled at least one prescription for 10 mg alendronate between October 1, 1995, and October 31, 1996. All the patients are members of the Kaiser Permanente Medical Care Program in Northern California. Based on interviews conducted a mean (SO) 8.0 (3.1) months after alendronate therapy was begun, 91.8% of the women recalled receiving verbal or printed instructions, but only 60% reported that they received all required instructions. During the course of therapy, 55.8% did not comply with one or more instructions for taking the drug. Specifically, 13.5% failed to comply with at least one of the recommended safety rules, and 51.7% disregarded rules relating to proximate ingestion of food, liquids (other than water), or medications. New upper-gastrointestinal symptoms ascribed to use of alendronate were reported by 32.7% of all users. The proportion of women discontinuing was 28.6% as based on self-report and was 34.9% as based on review of prescription refills. The most common reason for discontinuation was gastrointestinal problems, reported by 51.9% of women who stopped taking the drug. Almost one in three women receiving alendronate as therapy for osteoporosis has alendronate-related gastrointestinal complaints, which often cause them to discontinue treatment. Patients who fail to comply with instructions for taking alendronate may incur side effects from the drug or may fail to achieve full therapeutic effect from its use.

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