*Review* **Non-Adherence to Anti-Osteoporosis Medication: Factors Influencing and Strategies to Overcome It. A Narrative Review**

**Giulia Rita Agata Mangano 1, Marianna Avola 1, Chiara Blatti 2, Alessia Caldaci 2, Marco Sapienza 2, Rita Chiaramonte 1, Michele Vecchio 1, Vito Pavone <sup>2</sup> and Gianluca Testa 2,\***


**Abstract:** To evaluate the reasons for inadequate adherence to osteoporosis therapy and to describe the strategies for improving adherence to and persistence with regular medications, we conducted a review of the literature. The primary outcome of the study was the determination of the factors adverse to the onset and maintenance of anti-osteoporosis therapies. Secondly, we focused on studies whose efforts led to finding different strategies to improve adherence and persistence. We identified a total of 26 articles. The most recurrent and significant factors identified were aging, polypharmacy, and smoking habits. Different strategies to guide patients in their osteoporosis care have been identified, such as monitoring and follow-up via telephone calls, email, and promotional meetings, and proactive care interventions such as medication monitoring, post-fracture care programs, and decision aids. Changes in the drugs regimen and dispensation are strategies tried to lead to better adherence and persistence, but also improved satisfaction of patients undergoing anti-osteoporosis treatment. Patient involvement is an important factor to increase medication persistence while using a flexible drugs regimen.

**Keywords:** osteoporosis; adherence medications; elderly; frailty; postmenopausal; fractures; post-fracture care; educational meeting; drug regimen; medication monitoring
