Calcified Tissue International

, Volume 93, Issue 3, pp 195–200

Treatment Thresholds for Osteoporosis and Reimbursability Criteria: Perspectives Associated with Fracture Risk-Assessment Tools

  • Silvano Adami
  • Francesco Bertoldo
  • Davide Gatti
  • Giovanni Minisola
  • Maurizio Rossini
  • Luigi Sinigaglia
  • Massimo Varenna
Editorial

DOI: 10.1007/s00223-013-9748-0

Cite this article as:
Adami, S., Bertoldo, F., Gatti, D. et al. Calcif Tissue Int (2013) 93: 195. doi:10.1007/s00223-013-9748-0

Abstract

The definition of osteoporosis was based for several years on bone mineral density values, which were used by most guidelines for defining treatment thresholds. The availability of tools for the estimation of fracture risk, such as FRAX™ or its adapted Italian version, DeFRA, is providing a way to grade osteoporosis severity. By applying these new tools, the criteria identified in Italy for treatment reimbursability (e.g., “Nota 79”) are confirmed as extremely conservative. The new fracture risk-assessment tools provide continuous risk values that can be used by health authorities (or “payers”) for identifying treatment thresholds. FRAX estimates the risk for “major osteoporotic fractures,” which are not counted in registered fracture trials. Here, we elaborate an algorithm to convert vertebral and nonvertebral fractures to the “major fractures” of FRAX, and this allows a cost-effectiveness assessment for each drug.

Keywords

Osteoporosis treatment Treatment threshold Pharmacoeconomics FRAX 

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Silvano Adami
    • 1
  • Francesco Bertoldo
    • 2
  • Davide Gatti
    • 1
  • Giovanni Minisola
    • 4
  • Maurizio Rossini
    • 1
  • Luigi Sinigaglia
    • 3
  • Massimo Varenna
    • 3
  1. 1.Rheumatology Unit, Department of MedicineUniversity of VeronaVeronaItaly
  2. 2.Internal MedicineUniversity of VeronaVeronaItaly
  3. 3.Rheumatology UnitG. Pini HospitalMilanItaly
  4. 4.Rheumatology UnitOspedale ForlaniniRomeItaly