Dad is home alone now. Last year, he broke a hip and now he uses a walker. The doctor has prescribed Fosamax for him. But I can’t get him to take it consistently. We are worried he’s going to fall and break something else. Any suggestions?

You are right to be concerned about the risk of falls and fractures in someone who has already had one fracture. The risk of another fracture does go up after the first one. And fractures are known to reduce function, increase disability, and even result in death.

Now for the good news. Medications like Fosamax (a bisphosphonates) have been shown to reduce fractures, especially hip fractures. Bisphosphonates help slow down how fast the bone is resorbed (destroyed). Everyday new bone cells are formed and old bone cells are resorbed or destroyed. During childhood, new bone cells are formed faster than old ones are destroyed. In the aging adult, resorption exceeds formation.

The problem of drug adherence is a major challenge in the treatment of osteoporosis. Adherence includes both treatment persistence (taking medications over a long period of time) and treatment compliance (taking the drug correctly).

Treatment persistence and compliance are important because the risk of a second hip fracture after the first is very high. Taking bisphosphonates reduces that risk. The mortality (death) rate after a hip fracture is also high (up to 50 per cent). And for those people who survive the fracture, half will never walk unassisted again and 25 per cent end up in a nursing home.

The first step may be to identify the reason(s) why your father isn’t taking the medication as prescribed. Is he purchasing the medication but not taking it? Or just not filling the prescription? Is there a lack of money (or perceived lack of money)? Some patients can afford the medication but see the price tag and balk at spending that much.

Or they may purchase the medication and then discontinue it later due to side effects. Some patients stop taking their bisphosphonates because they don’t understand why it’s important to take these medications as prescribed over a lifetime. Since there aren’t very many (if any) obvious symptoms of osteoporosis, it’s easy to think, I don’t really need this drug.

The new and improved dosing (one pill each month instead of daily pills) may help improve adherence and reduce the rate of hip fractures. You may want to check with the pharmacist and see what kind of dosing schedule there is with the current medication. It may be easier to gain his cooperation and monitor his drug taking if it’s on a once a week or once a month basis rather than daily dosage.

And finally, ask your father’s prescribing physician to help monitor his compliance. Sometimes a brief explanation from the doctor is all that the patient needs to get on the program and stay there.