Original Article

Osteoporosis International

, Volume 24, Issue 1, pp 163-177

Cost-effectiveness of bone densitometry among Caucasian women and men without a prior fracture according to age and body weight

  • J. T. SchousboeAffiliated withPark Nicollet InstituteDivision of Health Policy and Management, University of Minnesota Email author 
  • , M. GourlayAffiliated withDepartment of Family Medicine, University of North Carolina
  • , H. A. FinkAffiliated withGeriatric Education and Research Center, Department of Veterans Affairs Health Care SystemDivision of Epidemiology and Community Health, University of Minnesota
  • , B. C. TaylorAffiliated withDivision of Epidemiology and Community Health, University of MinnesotaCenter for Chronic Diseases Outcomes Research, Department of Veterans Affairs Health Care SystemDepartment of Medicine, University of Minnesota
  • , E. S. OrwollAffiliated withDepartment of Medicine, Oregon Health Sciences University
  • , E. Barrett-ConnorAffiliated withUniversity of California, San Diego
  • , L. J. MeltonIIIAffiliated withPark Nicollet InstituteDivision of Epidemiology, Mayo Clinic
  • , S. R. CummingsAffiliated withPark Nicollet InstituteSan Francisco Coordinating CenterCalifornia Pacific Medical Center Research Institute
  • , K. E. EnsrudAffiliated withDivision of Epidemiology and Community Health, University of MinnesotaCenter for Chronic Diseases Outcomes Research, Department of Veterans Affairs Health Care SystemDepartment of Medicine, University of Minnesota
    • , For the Osteoporotic Fractures in Men (MrOS) and Study of Osteoporotic Fractures (SOF) Research Groups

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Abstract

Summary

We used a microsimulation model to estimate the threshold body weights at which screening bone densitometry is cost-effective. Among women aged 55–65 years and men aged 55–75 years without a prior fracture, body weight can be used to identify those for whom bone densitometry is cost-effective.

Introduction

Bone densitometry may be more cost-effective for those with lower body weight since the prevalence of osteoporosis is higher for those with low body weight. Our purpose was to estimate weight thresholds below which bone densitometry is cost-effective for women and men without a prior clinical fracture at ages 55, 60, 65, 75, and 80 years.

Methods

We used a microsimulation model to estimate the costs and health benefits of bone densitometry and 5 years of fracture prevention therapy for those without prior fracture but with femoral neck osteoporosis (T-score ≤ −2.5) and a 10-year hip fracture risk of ≥3%. Threshold pre-test probabilities of low BMD warranting drug therapy at which bone densitometry is cost-effective were calculated. Corresponding body weight thresholds were estimated using data from the Study of Osteoporotic Fractures (SOF), the Osteoporotic Fractures in Men (MrOS) study, and the National Health and Nutrition Examination Survey (NHANES) for 2005–2006.

Results

Assuming a willingness to pay of $75,000 per quality adjusted life year (QALY) and drug cost of $500/year, body weight thresholds below which bone densitometry is cost-effective for those without a prior fracture were 74, 90, and 100 kg, respectively, for women aged 55, 65, and 80 years; and were 67, 101, and 108 kg, respectively, for men aged 55, 75, and 80 years.

Conclusions

For women aged 55–65 years and men aged 55–75 years without a prior fracture, body weight can be used to select those for whom bone densitometry is cost-effective.

Keywords

Body weight Bone densitometry Cost-effectiveness Osteoporosis screening