Insufficient persistence to pharmacotherapy in Japanese patients with osteoporosis: an analysis of the National Database of Health Insurance Claims and Specific Health Checkups in Japan

Summary In Japan, persistence and the 2-year MPR were inadequate in increasing fracture control efficacy despite a high adherence rate during the treatment period. Both factors were higher in females and those with polypharmacy but worsened with increasing age. Purpose Only a few large-scale studies have examined the care gap between the patients who need osteoporosis treatment and those who receive them in Japan. The aim of this study was to investigate the persistence and adherence to osteoporosis pharmacotherapy in Japan. Methods Continuation (persistence) rates and adherence to osteoporosis pharmacotherapy were investigated using medical insurance data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan, between April 2012 and March 2019. Results The study included 528,806 male and 3,064,410 female patients. Persistence proportions were 56.6% in the first year and 46.3% in the second year. The medication possession ratio (MPR) from start to discontinuation of treatment (MPR discon ) was 94.5%, and 92.7% of patients had an MPR discon ≥ 80%. The 2-year MPR (MPR 730 ) was 61.9%, and 49.6% of patients had an MPR 730 ≥ 80%. Both the persistence proportion and MPR 730 were higher in females than in males, whereas MPR discon was higher in males. The persistence proportion and MPR 730 were highest in the 70–79 years age group, whereas MPR discon improved with increasing age. The MPR discon and MPR 730 were higher in the mixed-fracture and vertebral-fracture groups, respectively. The persistence proportion, MPR discon , and MPR 730 were higher in patients with polypharmacy than in those without. Conclusion In Japan, persistence and the 2-year MPR were inadequate in increasing fracture control efficacy despite a high adherence rate during the treatment period. To bridge the care gap following osteoporosis pharmacotherapy, improvements are required for males, the elderly, and those without polypharmacy.