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Potential for bone turnover markers to cost-effectively identify and select post-menopausal osteopenic women at high risk of fracture for bisphosphonate therapy

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Abstract

Introduction and hypothesis

Over half of all fractures among post-menopausal women occur in those who do not have osteoporosis by bone density criteria. Measurement of bone turnover may cost-effectively identify a subset of women with T-score >−2.5 for whom anti-resorptive drug therapy is cost-effective.

Methods

Using a Markov model, we estimated the cost per quality adjusted life year (QALY) for five years of oral bisphosphonate compared to no drug therapy for osteopenic post-menopausal women aged 60 to 80 years with a high (top quartile) or low (bottom 3 quartiles) level of a bone turnover marker.

Results

For women with high bone turnover, the cost per QALY gained with alendronate compared to no drug therapy among women aged 70 years with T-scores of −2.0 or −1.5 were $58,000 and $80,000 (U.S. 2004 dollars), respectively. If bisphosphonates therapy also reduced the risk of non-vertebral fractures by 20% among osteopenic women with high bone turnover, then the costs per QALY gained were $34,000 and $50,000 for women age 70 with high bone turnover and T-scores of −2.0 and −1.5, respectively.

Conclusion

Measurement of bone turnover markers has the potential to identify a subset of post-menopausal women without osteoporosis by bone density criteria for whom bisphosphonate therapy to prevent fracture is cost-effective. The size of that subset highly depends on the assumed efficacy of bisphosphonates for fracture risk reduction among women with both a T-score >−2.5 and high bone turnover and the cost of bisphosphonate treatment.

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Disclosure

John T. Schousboe, MD, MS: None, Douglas C. Bauer, MD: None, John A. Nyman, PhD: None, Robert L. Kane, MD: None, L. Joseph Melton, MD, MPH: None, Kristine E. Esnrud, MD, MPH: None

Author information

Authors and Affiliations

  1. Park Nicollet Health Services, 3800 Park Nicollet Blvd, Minneapolis, MN, 55416, USA

    J. T. Schousboe

  2. Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    J. T. Schousboe, J. A. Nyman & R. L. Kane

  3. Department of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    D. C. Bauer

  4. Clinical Outcomes Research Center, University of Minnesota, Minneapolis, MN, USA

    R. L. Kane

  5. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA

    L. J. Melton

  6. Department of Medicine, Minneapolis VAMC, Minneapolis, MN, USA

    K. E. Ensrud

  7. Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    K. E. Ensrud

Authors
  1. J. T. Schousboe
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  2. D. C. Bauer
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  3. J. A. Nyman
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  4. R. L. Kane
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  5. L. J. Melton
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  6. K. E. Ensrud
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Corresponding author

Correspondence to J. T. Schousboe.

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Schousboe, J.T., Bauer, D.C., Nyman, J.A. et al. Potential for bone turnover markers to cost-effectively identify and select post-menopausal osteopenic women at high risk of fracture for bisphosphonate therapy. Osteoporos Int 18, 201–210 (2007). https://doi.org/10.1007/s00198-006-0218-7

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  • DOI: https://doi.org/10.1007/s00198-006-0218-7

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