Osteoporosis International

, Volume 16, Issue 1, pp 6–14 | Cite as

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

  • John A. KanisEmail author
  • Olof Johnell
  • Anders Oden
  • Frederik Borgstrom
  • Helena Johansson
  • Chris De Laet
  • Bengt Jönsson
Original Article


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 



We are grateful to the International Osteoporosis Foundation, Pfizer, Alliance for Better Bone Health, IGEA, Lilly Research Centre, Hologic, Novartis, Wyeth, and Roche for their unrestricted support of these studies.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • John A. Kanis
    • 1
    Email author
  • Olof Johnell
    • 2
  • Anders Oden
    • 3
  • Frederik Borgstrom
    • 4
  • Helena Johansson
    • 3
  • Chris De Laet
    • 5
  • Bengt Jönsson
    • 4
  1. 1.Centre for Metabolic Bone Diseases (WHO Collaborating Centre)University of Sheffield Medical SchoolSheffieldUK
  2. 2.Department of OrthopaedicsMalmo General HospitalMalmoSweden
  3. 3.Consulting StatisticianRomelandaSweden
  4. 4.Stockholm Health EconomicsStockholmSweden
  5. 5.Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands

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