Prevalence of Medication Nonadherence among Osteoporosis Patients: A Cross-Sectional Study in Tabuk, Saudi Arabia

Prevalence of Medication Nonadherence among Osteoporosis Patients: A Cross-Sectional Study in Tabuk, Saudi Arabia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Medication Nonadherence among Osteoporosis Patients: A Cross-Sectional Study in Tabuk, Saudi Arabia Afaf Abdullah M. Albalawi, Basim S.O. Alsaedi, Sami M. Assil, MD, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7885492/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2026 Read the published version in Annals of African Medicine → Version 1 posted You are reading this latest preprint version Abstract Background: Despite the wide use of effective anti-osteoporotic therapies, adherence remains suboptimal worldwide, including in Saudi Arabia. Identifying factors associated with nonadherence—such as medication modality and patient characteristics—is vital for informing effective interventions. Objectives: This study aimed to assess the prevalence of osteoporosis medication nonadherence and to examine clinical, behavioral, and treatment-related predictors, including drug type and dosing regimen, among adult patients in Tabuk, Saudi Arabia. Methods: We conducted a cross-sectional study of 137 adults with osteoporosis receiving anti-osteoporotic treatment at a tertiary care center in Tabuk, Saudi Arabia. The data collected included demographic characteristics, comorbidities, concurrent medications, history of fragility fractures, medication type (oral vs. injectable), and dosing regimen. Adherence was assessed using the validated Morisky Medication Adherence Scale (MMAS-8), administered via structured patient interviews in person or via telephone, and verified against medical records. Nonadherence was defined as a <80% medication possession ratio. Multivariable logistic regression with an 80/20 training-test split was performed to develop a risk stratification model. A clinical nomogram was created for practical application of the model. Results: The prevalence of medication nonadherence was 29.9% (95% CI: 22.5–38.2%). The area under the ROC curve of the proposed combined risk model was 0.704 (95% CI: 0.454–0.921). The model successfully stratified patients into three risk categories: high (2.2% of the cohort, 0% adherence), moderate (35.8%, 61.2% adherence), and low risk (62.0%, 77.6% adherence). At the optimal cutoff, the model yielded 73.7% sensitivity and 75.0% specificity. A clinical nomogram was developed for bedside risk assessment. Conclusion: Nearly one-third of osteoporosis patients were nonadherent, indicating a persistent care gap. Although no individual clinical factors independently predicted nonadherence, our risk stratification model showed good discriminability (AUC 0.704) and separated patients into three risk groups with adherence rates ranging from 0% to 77.6%. The clinical nomogram provides a practical tool for rapid bedside risk assessment, enabling 2 targeted allocation of adherence support resources. Multicenter validation and intervention studies are needed before wider use of the proposed model. General Practice Osteoporosis Medication adherence Risk stratification Bisphosphonates Nomogram Saudi Arabia Polypharmacy Fragility fracture Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2026 Read the published version in Annals of African Medicine → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7885492","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":531145717,"identity":"00ddc299-fd73-455e-bcb7-ecc5fdd9b49e","order_by":0,"name":"Afaf Abdullah M. 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Identifying factors associated with \u0026nbsp;nonadherence—such as medication modality and patient characteristics—is vital for \u0026nbsp;informing effective interventions. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives: \u003c/strong\u003e\u0026nbsp;\u0026nbsp;This study aimed to assess the prevalence of osteoporosis medication nonadherence \u0026nbsp;and to examine clinical, behavioral, and treatment-related predictors, including drug \u0026nbsp;type and dosing regimen, among adult patients in Tabuk, Saudi Arabia. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e \u0026nbsp;\u0026nbsp;We conducted a cross-sectional study of 137 adults with osteoporosis receiving \u0026nbsp;anti-osteoporotic treatment at a tertiary care center in Tabuk, Saudi Arabia. The data \u0026nbsp;collected included demographic characteristics, comorbidities, concurrent medications, \u0026nbsp;history of fragility fractures, medication type (oral vs. injectable), and dosing regimen. \u0026nbsp;Adherence was assessed using the validated Morisky Medication Adherence Scale \u0026nbsp;(MMAS-8), administered via structured patient interviews in person or via telephone, \u0026nbsp;and verified against medical records. Nonadherence was defined as a \u0026lt;80% medication \u0026nbsp;possession ratio. Multivariable logistic regression with an 80/20 training-test split was \u0026nbsp;performed to develop a risk stratification model. A clinical nomogram was created for \u0026nbsp;practical application of the model. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u0026nbsp;\u0026nbsp;\u003c/strong\u003eThe prevalence of medication nonadherence was 29.9% (95% CI: 22.5–38.2%). The \u0026nbsp;area under the ROC curve of the proposed combined risk model was 0.704 (95% CI: \u0026nbsp;0.454–0.921). The model successfully stratified patients into three risk categories: high \u0026nbsp;(2.2% of the cohort, 0% adherence), moderate (35.8%, 61.2% adherence), and low risk \u0026nbsp;(62.0%, 77.6% adherence). At the optimal cutoff, the model yielded 73.7% sensitivity \u0026nbsp;and 75.0% specificity. A clinical nomogram was developed for bedside risk assessment. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e \u0026nbsp;\u0026nbsp;Nearly one-third of osteoporosis patients were nonadherent, indicating a persistent care \u0026nbsp;gap. Although no individual clinical factors independently predicted nonadherence, our \u0026nbsp;risk stratification model showed good discriminability (AUC 0.704) and separated \u0026nbsp;patients into three risk groups with adherence rates ranging from 0% to 77.6%. The \u0026nbsp;clinical nomogram provides a practical tool for rapid bedside risk assessment, enabling \u0026nbsp;2 \u0026nbsp;targeted allocation of adherence support resources. Multicenter validation and \u0026nbsp;intervention studies are needed before wider use of the proposed model. \u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Prevalence of Medication Nonadherence among Osteoporosis Patients: A Cross-Sectional Study in Tabuk, Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-03 02:40:25","doi":"10.21203/rs.3.rs-7885492/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d7bb7fdc-5038-4363-bc1f-d5fdfd1bea01","owner":[],"postedDate":"November 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":57204957,"name":"General Practice"}],"tags":[],"updatedAt":"2026-05-14T17:56:59+00:00","versionOfRecord":{"articleIdentity":"rs-7885492","link":"https://doi.org/10.4103/aam.aam_799_25","journal":{"identity":"annals-of-african-medicine","isVorOnly":true,"title":"Annals of African Medicine"},"publishedOn":"2026-03-19 00:00:00","publishedOnDateReadable":"March 19th, 2026"},"versionCreatedAt":"2025-11-03 02:40:25","video":"","vorDoi":"10.4103/aam.aam_799_25","vorDoiUrl":"https://doi.org/10.4103/aam.aam_799_25","workflowStages":[]},"version":"v1","identity":"rs-7885492","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7885492","identity":"rs-7885492","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}