Clin Osteol 2026; 31(2): 97-104 | DOI: 10.36290/clo.2026.015

The impact of patient adherence on the efficacy of osteoporosis pharmacotherapyOriginal contributions

Mária Kolesárová¹, Ľudmila Pavlíková¹, Dana Marcinčáková¹, Zuzana Mačeková², Dalibor Kolesár³, Ladislav Seman⁴, Ján Kyselovič⁵

¹ Department of Pharmacology and Toxicology, University of Veterinary Medicine and Pharmacy in Košice, Košice, Slovak Republic

² Department of Pharmacy and Social Pharmacy, University of Veterinary Medicine and Pharmacy in Košice, Slovak Republic

³ Department of Anatomy, Faculty of Medicine in Košice, Pavol Jozef Šafárik University, Košice, Slovak Republic

⁴ Rheumatology Clinic, Procare Polyclinic in Prešov, Slovak Republic

⁵ Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic

Background: Clinical trials demonstrate that osteoporosis pharmacotherapy reduces fracture incidence by approximately 50%. However, this therapeutic benefit may be severely compromised by sub-optimal patient adherence in real-world clinical practice. The primary objective of this retrospective study was to evaluate the long-term efficacy of osteoporosis pharmacotherapy and assess patient adherence levels using the ADEOS-12 questionnaire, with a specific focus on analysing the correlation between adherence scores and objective clinical outcomes, including bone mineral density (BMD) and biochemical bone turnover markers.

Methods: Medication adherence was evaluated using the standardized Adherence Evaluation of Osteoporosis Treatment (ADEOS-12) questionnaire. Therapeutic efficacy was assessed via biochemical markers of bone metabolism—specifically osteocalcin, the collagen degradation product beta-isomerized C-terminal telopeptide of type I collagen (beta-CTX), vitamin D, and urinary calcium excretion—alongside dual-energy X-ray absorptiometry (DXA) densitometric examinations of the lumbar spine and femoral neck (T-scores). Data were analysed from fifty-one patients across three timepoints: 2020, 2022, and 2024. Statistical analyses and correlation assessments were performed using GraphPad Prism (version 10. 4. 1).

Results: The cohort comprised 98% (n = 50) women, with a mean age of 69.27 ± 7.76 years. The predominant clinical diagnosis was postmenopausal osteoporosis (ICD-10: M81.00; 96%). Among the monitored laboratory parameters, only beta-CTX demonstrated a statistically significant change, declining from a mean baseline of 354.64 ± 186.24 pg/mL in 2020 to 256.59 ± 107.56 pg/mL in 2024. Lumbar spine T-scores improved significantly between 2022 (-2.31 ± 0.88) and 2024 (-2.14 ± 0.87), indicating a positive long-term therapeutic effect. ADEOS-12 outcomes revealed that 63% of patients achieved scores indicating a high probability of adherent behavior. Due to the limited sample size of the enrolled cohort, only weak, statistically non-significant (p > 0.05) positive correlations were observed between adherence scores and bone markers (osteocalcin: rs = 0.1518; beta-CTX: rs = 0.2638; vitamin D: rs = 0.06357; urinary calcium: rs = 0.0004210) or bone mineral density (lumbar spine T-score: rs = 0.1496; femoral neck T-score: rs = 0.1651).

Conclusion: Optimally tailored pharmacotherapy for osteoporosis, supplemented by systematic monitoring of biochemical and densitometric parameters alongside adherence tracking, significantly improves bone mineral density and stabilizes metabolic indicators of bone turnover.

Keywords: osteoporosis, pharmacotherapy, medication adherence, ibandronate, denosumab, dual-energy X-ray absorptiometry

Accepted: June 12, 2026; Published: July 1, 2026  Show citation