Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective?

Sanders, Kerrie M., Nicholson, Geoffrey C., Watts, Jennifer J., Pascoe, Julie A., Henry, Margaret J., Kotowicz, Mark A. and Seeman, Ego (2006) Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective?. Bone, 38 5: 694-700. doi:10.1016/j.bone.2005.06.004


Author Sanders, Kerrie M.
Nicholson, Geoffrey C.
Watts, Jennifer J.
Pascoe, Julie A.
Henry, Margaret J.
Kotowicz, Mark A.
Seeman, Ego
Title Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective?
Journal name Bone   Check publisher's open access policy
ISSN 8756-3282
1873-2763
Publication date 2006-05-01
Sub-type Article (original research)
DOI 10.1016/j.bone.2005.06.004
Open Access Status Not Open Access
Volume 38
Issue 5
Start page 694
End page 700
Total pages 7
Place of publication Philadelphia, PA, United States
Publisher Elsevier
Language eng
Abstract To determine the age- and BMD-specific burden of fractures in the community and the cost-effectiveness of targeted drug therapy, we studied a demographically well-categorized population with a single main health provider. Of 1224 women over 50 years of age sustaining fractures during 2 years, the distribution of all fractures was 11%, 20%, 33%, and 36% in those aged 50-59, 60-69, 70-79, and 80+ years, respectively. Osteoporosis (T score < -2.5) was present in 20%, 46%, 59%, and 69% in the respective age groups. Based on this sample and census data for the whole country, treating all women over 50 years of age in Australia with a drug that halves fracture risk in osteoporotic women and reduces fractures in those without osteoporosis by 20%, was estimated to prevent 18,000 or 36% of the 50,000 fractures per year at a total cost of $573 million (AUD). Screening using a bone mineral density of T score of -2.5 as a cutoff, misses 80%, 54%, 41%, and 31% of fractures in women in the respective age groups. An analysis of cost per averted fracture by age group suggests that treating women in the 50- to 59-year age group with osteoporosis alone costs $156,400 per averted fracture. However, in women aged over 80 years, the cost per averted fracture is $28,500. We infer that treating all women over 50 years of age is not feasible. Using osteoporosis and age (>60 years) as criteria for intervention reduces the population burden of fractures by 28% and is cost-effective but solutions to the prevention of the remaining 72% of fragility fractures remain unavailable.
Keyword Osteoporosis-diagnosis
Anti-resorptive drugs
Epidemiology
Cost-effectiveness
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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