Original Article

Osteoporosis International

, Volume 18, Issue 2, pp 201-210

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

  • J. T. SchousboeAffiliated withPark Nicollet Health ServicesDivision of Health Services Research and Policy, School of Public Health, University of Minnesota Email author 
  • , D. C. BauerAffiliated withDepartment of Medicine, Epidemiology and Biostatistics, University of California San Francisco
  • , J. A. NymanAffiliated withDivision of Health Services Research and Policy, School of Public Health, University of Minnesota
  • , R. L. KaneAffiliated withDivision of Health Services Research and Policy, School of Public Health, University of MinnesotaClinical Outcomes Research Center, University of Minnesota
  • , L. J. MeltonAffiliated withDivision of Epidemiology, Department of Health Sciences Research, Mayo Clinic
  • , K. E. EnsrudAffiliated withDepartment of Medicine, Minneapolis VAMCDivision of Epidemiology, School of Public Health, University of Minnesota

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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.

Keywords

Bisphosphonates Bone turnover Cost-effectiveness Non-vertebral fracture Vertebral fracture