Osteoporosis International

, Volume 22, Issue 3, pp 771–780

Development and validation of a disease model for postmenopausal osteoporosis

  • A. Gauthier
  • J. A. Kanis
  • M. Martin
  • J. Compston
  • F. Borgström
  • C. Cooper
  • E. McCloskey
  • On behalf of the Committee of Scientific Advisors, International Osteoporosis Foundation
Original Article

DOI: 10.1007/s00198-010-1358-3

Cite this article as:
Gauthier, A., Kanis, J.A., Martin, M. et al. Osteoporos Int (2011) 22: 771. doi:10.1007/s00198-010-1358-3



This article describes the development of a model for postmenopausal osteoporosis (PMO) based on Swedish data that is easily adaptable to other countries.


The aims of the study were to develop and validate a model to describe the current/future burden of PMO in different national settings.


For validation purposes, the model was developed using Swedish data and provides estimates from 1990. For each year of the study, the “incident cohort” (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures and death. Fracture by site (hip, vertebral, and non-hip non-vertebral) was tracked for each health state. Transition probabilities reflected site-specific risk of death and subsequent fractures. Bone mineral density (BMD) was included as a model output; model inputs included population size and life tables from 1970 to 2020, incidence of fracture, relative risk of subsequent fractures based on prior fracture, relative risk of death following a fracture by site, and BMD by age (mean and standard deviation).


Model predictions averaged across age groups estimated the incidence of hip, vertebral, and other osteoporotic fractures within a 5% margin of error versus published data. In Sweden, the number of osteoporotic fractures is expected to rise by 11.5% between 2009 and 2020, with a shift towards more vertebral fractures and multiple fractures.


The current PMO disease model is easily adaptable to other countries, providing a consistent measure of present and future burden of PMO in different settings.


Bone mineral densityEpidemiologyFractureOsteoporosisT-score

Supplementary material

198_2010_1358_MOESM1_ESM.docx (18 kb)
ESM 1Probability of first fracture [12, 13] (DOCX 15 kb)
198_2010_1358_MOESM2_ESM.docx (16 kb)
ESM 2Increased risk* of fracture following a previous fracture [9, 10] (DOCX 16 kb)
198_2010_1358_MOESM3_ESM.docx (16 kb)
ESM 3Relative risk of death following a hip or vertebral fracture [7, 8] (DOCX 15 kb)
198_2010_1358_MOESM4_ESM.docx (15 kb)
ESM 4Mean bone mineral density (BMD) and standard deviation (SD) by age group [18] (DOCX 15 kb)

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • A. Gauthier
    • 1
    • 2
  • J. A. Kanis
    • 3
  • M. Martin
    • 4
  • J. Compston
    • 5
  • F. Borgström
    • 6
    • 7
  • C. Cooper
    • 8
    • 9
  • E. McCloskey
    • 3
  • On behalf of the Committee of Scientific Advisors, International Osteoporosis Foundation
  1. 1.University of GlasgowGlasgowUK
  2. 2.Amaris Consulting UK LtdLondonUK
  3. 3.University of SheffieldSheffieldUK
  4. 4.i3 InnovusMiddlesexUK
  5. 5.University of Cambridge School of Clinical MedicineCambridgeUK
  6. 6.i3 InnovusStockholmSweden
  7. 7.LIME/MMC, Karolinska InstituteStockholmSweden
  8. 8.University of SouthamptonSouthamptonUK
  9. 9.University of OxfordOxfordUK