Majority of osteoporosis patients not receiving calcium and vitamin D with treatment

Geneva, Switzerland – 15th September, 2008: New research published today at the annual meeting of the American Society for Bone and Mineral Research (ASBMR), Montréal, Canada, reveals that less than half (43%) of patients in Europe with osteoporosis are claiming to take both calcium and vitamin D supplementation with their osteoporosis treatment. Maximum benefit in managing osteoporosis can be achieved with combination therapy of an osteoporosis treatment (such as a bisphosphonate) with calcium and vitamin D supplementation, yet the majority of patients in this research claim they do not follow this approach.

"Patients with a low intake of calcium and vitamin D may not be receiving the full benefit of their osteoporosis treatment if they do not take enough supplementation", said Professor Steven Boonen MD, PhD, of Leuven University in Belgium and lead author of the abstract reporting the research results. "It is important that patients not only take both their calcium and vitamin D supplements, but also to ensure that they take them regularly".

The patient research was conducted amongst 383 women aged 50 years and older who had been diagnosed and treated for post-menopausal osteoporosis in France (n=97), Germany (n=98), Spain (n=94) and the UK (n=94). The aim of the study was to evaluate treatment knowledge and behaviour in women receiving treatment for their osteoporosis with regard to their calcium and vitamin D supplementation.

Even when patients do take some form of supplementation, up to 30% claim they regularly miss a dose. An analysis of those patients who declared they were regularly missing a supplement dose revealed this was due either to the fact that they were not convinced of the importance of supplementation, or that they did not receive a detailed explanation from their treating physician. i Patient responses also showed that there is a need for some sort of aid, for example, a tool or packaging that would help them take their osteoporosis medication and supplementation. i This need for help is supported by patient preference data, which shows that over 70% of patients believe that providing a bisphosphonate with calcium and vitamin D in one box can help them take their supplements regularly and correctly.

The research highlights interesting differences in attitudes to supplementation across the four European countries. These study results showed that Spain generally proved to be a leader in terms of patient behaviour and knowledge about supplementation. For example, when looking at supplement use, 90% of patients in Spain claimed that they were taking some form of supplementation (calcium alone, vitamin D alone or calcium and vitamin D) with their osteoporosis treatment, compared to as few as 61% in the UK and 69% in France. i Similarly, patients in Spain claimed to discuss supplementation with their physician more regularly than in other countries - 51% compared to 36% in Germany, 24% in France and 9% in the UK.

Patient trends in the UK highlighted areas for improvement. As well as being the lowest users of supplements and one of the least likely to recognise the importance of calcium and vitamin D supplementation, almost a third of UK patients claimed to have never discussed supplementation with their physician. iv

When it came to adhering to supplements, women in France appeared to be the most disciplined out of the four countries, with only 13% claiming to regularly miss a dose of any supplement. This was in contrast to the UK, where almost one in three patients reported regularly missing a supplement dose. i

"The disparities between countries in attitudes to supplementation may be due to differences in cultures, national health policies or local disease awareness initiatives" said Doctor Patrice Fardellone, of CHU Amiens Hospital in France. "Whilst this research has shown some positive results, there is still room for improvement. It is vital that clinicians continue to educate their patients on the importance of supplements and encourage them to see supplementation as part of complete osteoporosis treatment."

The aim of the patient research was to gain an understanding, on a pan-European basis, of the habits and attitudes of osteoporosis patients regarding supplementation with calcium or vitamin D or calcium plus vitamin D with their osteoporosis treatment (bisphosphonate). The research was conducted by IPSOS Suisse SA. i A total of 383 women across four countries (France, Germany, Spain and the UK) currently taking bisphosphonate treatment for osteoporosis were interviewed. A mixed data collection methodology was used to survey the patients, including online panels (UK, Spain), face to face interviews (Germany) and mail panel (France).

Patients in Europe with osteoporosis claiming to take both calcium and vitamin D supplementation with their osteoporosis treatment were split across the four countries as follows:

• Spain - 43%
• UK - 37%
• Germany - 49%
• France - 46%

Even when patients do take some form of supplementation, up to 30% claim they regularly miss a dose (13% in France, 19% in Germany, 30% in the U.K. and 27% in Spain).

• Claimed data: All data from the market research is 'claimed data' i.e. based on patient's testimonials on their habits and beliefs regarding supplementation and their consultation experience
• Data collection: Different methodology was used to collect the data across the four countries (as shown above). This could cause some bias when comparing countries
• Selected statements: European averages provided are based on results of selected statements from market research. Comparisons have been made using the general ranking, which provides an indication of which country is leading and require further refinement. The full results of the market research are available from Procter & Gamble
• Cultural bias: There may be cultural differences in patient reporting, with some countries over-claiming and others under-claiming about their experiences
• The total figures for all countries: These are based on a simple average of the various countries under study. This average is not weighted by country population or by other relevant factors

Osteoporosis is a skeletal disease that increases bone fragility and susceptibility to fracture. Fracture is a devastating consequence of osteoporosis and can occur at any site of the body. A 50-year-old woman has around a 40% lifetime risk of suffering a fracture from osteoporosis.

Currently, osteoporosis accounts for 1.6 million hip fractures worldwide per year. Amongst those patients who suffer a hip fracture, approximately one in five will die within the following year, , and 40 percent will be unable to walk independently one year later.

Three billion times a day, P&G brands touch the lives of people around the world. The company has one of the strongest portfolios of trusted, quality, leadership brands, including Pampers®, Tide®, Ariel®, Always®, Whisper®, Pantene®, Mach3®, Bounty®, Dawn®, Pringles®, Folgers®, Downy®, Lenor®, Iams®, Crest®, Oral-B®, Actonel®, Duracell®, Intrinsa® Olay®, Head & Shoulders®, Wella, Gillette®, and Braun. The P&G community consists of over 135,000 employees working in over 80 countries worldwide. Please visit http://www.pg.com for the latest news and in-depth information about P&G and its brands.

Boonen S, Fardellone P, Quesada J, et al. OP patients' behaviours and understanding of the importance of calcium and vitamin D supplementation. ASBMR [abstract] September 2008

Boonen, S et al. The need for clinical guidance in the use of calcium and vitamin D in the management of osteoporosis: a consensus report. Osteoporosis International, 2004; 15:511-519

Fardellone P, et al. A new combination packaging for osteoporosis treatment; patient preference and expected adherence to the therapy. Calcified Tissue International, 2007;80(supp 1):s143 (P332-T)

Osteoporosis supplement co-prescribing versus recommendation compliance study. IPSOS Suisse. December 2007. P&G data on file

Melton LJ, et al. Perspective. How many women have osteoporosis? J Bone Miner Res 1992; 7: 1005-1010

International Osteoporosis Foundation. Facts and statistics about osteoporosis and its impact. http://www.osteofound.org/press_centre/fact_sheet.html

Cooper C, Atkinson EJ, Jacobsen SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol 1993; 137:1001-1005

Leibson CL, Tosteson AN, Gabriel SE, et al. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 2002; 50: 1644-1650

Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 1990; 45: M101-M107