Background Osteoporosis is a disease characterised by underdiagnosis and undertreatment. Persistence and adherence are an important problem in patients treated for osteoporosis.

Purpose To evaluate and monitor the use of bisphosphonates considering the appropriateness either with regard to the indication/limitation or to the persistence to the treatment.

Materials and methods The authors investigated the patients in Cosenza health district (Italy) in the years 2009 and 2010. The whole population is 291,086 (51.3% women and 48.7% men). 9694 patients were treated with raloxifene, alendronic acid – alone or in association with cholecalciferol -, ibandronic acid, risedronic acid, strontium ranelate: 92.34% women and only 284 patients above 50 years old.

Results 56.2% of patients took raloxifene for less than 25% of the investigational period (six months); 11.9% took it for 25% – 50% of the investigational period (6-12 months); 18.9% took it between 50% and 75% of the time (12-18 months) and 13% took it for more than 75% of the time. Of the patients treated with alendronic acid, alone or in combination with cholecalciferol, 53.3% took the drug less than 25% of the investigational period, 13.3% for between 25% and 50%, 20.7% for between 50% and 75% and 12.7% took it for more than 75% of the time. 49.8% of the patients treated by ibandronic acid took the drug less than 25% of the investigational period, 13.4% took it between 25% and 50% of the time, 21.2% had it between 50% and 75% and 15.6% had it for more than 75% of the time. 52.2% of the patients treated by risedronic acid had the drug less than 25% of the investigational period, 12.6% had it between 25% and 50% of the time, 21.9% had it between 50% and 75% of the time and 13.3% had it more than 75% of the time. 75.8% of the patients treated by strontium ranelate took the drug less than 25% of the period studied, 9.6% took it between 25% and 50% of the time, 11.7% took it between 50% and 75% of the period studied and only 2.9% lasted for more than 75% of the time.

Conclusions Our observations confirm the underdiagnosis and the undertreatment of osteoporosis. Appropriate prescribing is the first step to adherence, the real target in chronic treatment.