Both for MPR and persistence rates, we found that the treatment regimen was a highly significant independent determinant of both MPR and persistence. With respect

to other variables independently associated with persistence or compliance, our findings were broadly consistent with previous reports. The influence of bone densitometry on reinforcing adherence has been a consistent finding of previous studies [16, 35], but is difficult to interpret here as the outcome of the evaluation (T-score) was not available. Calcium or vitamin D supplementation has previously been reported to be associated with better compliance and improved fracture outcome in the ICARO study [38]. Such selleck kinase inhibitor dietary supplementation may also be indicative

of higher motivation. Likewise, patients with a neurological disorder (notably epilepsy, Alzheimer or Parkinson’s disease) were more persistent than others, which may reflect awareness of physicians about the high risk of fracture in such patients [39–41], as well as, for patients with epilepsy, a history of treatment for which good adherence is critical. Topical products for joint and muscular pain mainly correspond to non-steroidal anti-inflammatory drugs. Those drugs could be prescribed for their analgesic effects on pain related to fractures, such as back pain with vertebral fractures. Relief of these symptoms may also lead patients Selleckchem 4SC-202 to be less adherent to treatment of osteoporosis. Even

though the absolute number of patients was low (70 patients in all), a significant association between a diagnosis of comorbid rheumatoid arthritis and low MPR and poor persistence was observed. The interpretation of this finding is unclear, but in the absence of further information on rheumatoid pathology, it merits exploration in a dedicated study. It is noteworthy that it has been previously reported that patients with rheumatoid arthritis taking oral glucocorticoids did not routinely undergo BCKDHA bone densitometry or receive prescription medications for osteoporosis [42]. An important determinant of the validity of our findings is the representativity of the source data. The Thales database has been demonstrated to be a reliable source of information in numerous previous studies in rheumatology [19, 24] and in other fields of medicine [43–46]. In addition, the proportions of patients with various comorbidities in our study sample are consistent with the known prevalence of these diseases in women over 45. This study has several limitations. Some of these are linked to the use of a primary care registry as the data source. The use of such databases for pharmacoepidemiological studies has become popular of recent years, since it allows access to information on a large number of patients gathered in real-world conditions [3, 47].