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. Schousboe
  • D. C. Bauer
  • J. A. Nyman
  • R. L. Kane
  • L. J. Melton
  • K. E. Ensrud
Original Article

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 

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2006

Authors and Affiliations

  • J. T. Schousboe
    • 1
    • 2
  • D. C. Bauer
    • 3
  • J. A. Nyman
    • 2
  • R. L. Kane
    • 2
    • 4
  • L. J. Melton
    • 5
  • K. E. Ensrud
    • 6
    • 7
  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 Medicine, Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Clinical Outcomes Research CenterUniversity of MinnesotaMinneapolisUSA
  5. 5.Division of Epidemiology, Department of Health Sciences ResearchMayo ClinicRochesterUSA
  6. 6.Department of MedicineMinneapolis VAMCMinneapolisUSA
  7. 7.Division of Epidemiology, School of Public HealthUniversity of MinnesotaMinneapolisUSA

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