Osteoporosis International

, Volume 16, Issue 12, pp 1883–1893 | Cite as

Potential cost-effective use of spine radiographs to detect vertebral deformity and select osteopenic post-menopausal women for amino-bisphosphonate therapy

  • John T. Schousboe
  • Kristine E. Ensrud
  • John A. Nyman
  • Robert L. Kane
  • L. Joseph MeltonIII
Original Article


Prevalent vertebral deformities are predictive of future clinical fractures independent of bone density. We used a Markov model with eight health states to estimate from the societal perspective the cost-effectiveness of using spine radiographs to identify postmenopausal women age 60 or older with one or more vertebral deformities and then treat them with anti-resorptive drug therapy to prevent fractures. We compared three strategies: 5 years of amino-bisphosphonate (alendronate) therapy for all, 5 years of alendronate therapy for only those with prevalent a radiographic vertebral deformity or no initial alendronate treatment. Lifetime direct medical and indirect costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were tracked. For women with one or more prevalent vertebral deformities, the costs per QALY gained ranged from $5,084 (for an 80 year old with a T-score of −2.4) to $61,192 (for a 60 year old with a T-score of −1.0). For women without prevalent vertebral deformity, the costs per QALY gained ranged from $41,897 (for a 60 year old with a T-score of −2.4) to $166,219 (for an 80 year old with a T-score of −1.0). These results were modestly sensitive to reasonable changes in fracture rates, disutility, discount rates and assumptions about the accuracy of spinal radiographs for detecting vertebral deformity. Assuming a societal willingness to pay per QALY gained of $50,000, the strategy of performing spine radiographs in post-menopausal osteopenic women with T-scores at or below –1.5 and treating those with 1 or more prevalent vertebral deformities is likely to be cost-effective. However, further research on the accuracy of vertebral deformity ascertainment from routine clinical radiographs and on the efficacy of amino-bisphosphonate drugs for reducing the risk of non-vertebral fractures in osteopenic women is needed to define more precisely the subset of osteopenic post-menopausal women in whom use of spinal radiographs is most cost-effective.


Amino-bisphosphonate therapy Cost-effectiveness Fracture Spine radiography 



Dr. Schousboe received research grant support from Hologic, Inc., and Dr. Ensrud received research grant support from Pfizer, Inc., and from Eli Lilly and Co.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • John T. Schousboe
    • 1
    • 2
  • Kristine E. Ensrud
    • 3
    • 4
  • John A. Nyman
    • 2
  • Robert L. Kane
    • 2
    • 5
  • L. Joseph MeltonIII
    • 6
  1. 1.Park Nicollet Health ServicesMinneapolisUSA
  2. 2.Division of Health Services Research and Policy, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  3. 3.Department of MedicineVeterans Administration Medical CenterMinneapolisUSA
  4. 4.Division of Epidemiology, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  5. 5.Clinical Outcomes Research CenterUniversity of MinnesotaMinneapolisUSA
  6. 6.Division of Epidemiology, Department of Health Sciences ResearchMayo ClinicRochesterUSA

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