Osteoporosis International

, Volume 16, Issue 1, pp 6–14

Intervention thresholds for osteoporosis in men and women: a study based on data from Sweden


    • Centre for Metabolic Bone Diseases (WHO Collaborating Centre)University of Sheffield Medical School
  • Olof Johnell
    • Department of OrthopaedicsMalmo General Hospital
  • Anders Oden
    • Consulting Statistician
  • Frederik Borgstrom
    • Stockholm Health Economics
  • Helena Johansson
    • Consulting Statistician
  • Chris De Laet
    • Department of Public HealthErasmus Medical Center
  • Bengt Jönsson
    • Stockholm Health Economics
Original Article

DOI: 10.1007/s00198-004-1623-4

Cite this article as:
Kanis, J.A., Johnell, O., Oden, A. et al. Osteoporos Int (2005) 16: 6. doi:10.1007/s00198-004-1623-4


The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing $500 per year given for 5 years that decreased the risk of all osteoporotic fractures by 35% followed by a waning of effect for a further 5 years. Sensitivity analyses included a range of effectiveness (10-50%) and a range of intervention costs ($200–500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately $45,000/QALY gained was used. Cost of added years was included in a sensitivity analysis. With the base case ($500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk.


Cost-effectivenessCost of added yearsHip fractureIntervention thresholdOsteoporotic fracture

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004