Original Article

Osteoporosis International

, Volume 16, Issue 1, pp 6-14

First online:

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

  • John A. KanisAffiliated withCentre for Metabolic Bone Diseases (WHO Collaborating Centre), University of Sheffield Medical School Email author 
  • , Olof JohnellAffiliated withDepartment of Orthopaedics, Malmo General Hospital
  • , Anders OdenAffiliated withConsulting Statistician
  • , Frederik BorgstromAffiliated withStockholm Health Economics
  • , Helena JohanssonAffiliated withConsulting Statistician
  • , Chris De LaetAffiliated withDepartment of Public Health, Erasmus Medical Center
  • , Bengt JönssonAffiliated withStockholm Health Economics

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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-effectiveness Cost of added years Hip fracture Intervention threshold Osteoporotic fracture