Osteoporosis International

, Volume 19, Issue 4, pp 437–447

Cost-effective osteoporosis treatment thresholds: the United States perspective

  • A. N. A. Tosteson
  • L. J. MeltonIII
  • B. Dawson-Hughes
  • S. Baim
  • M. J. Favus
  • S. Khosla
  • R. L. Lindsay
Special Position Paper

DOI: 10.1007/s00198-007-0550-6

Cite this article as:
Tosteson, A.N.A., Melton, L.J., Dawson-Hughes, B. et al. Osteoporos Int (2008) 19: 437. doi:10.1007/s00198-007-0550-6



A United States-specific cost-effectiveness analysis, which incorporated the cost and health consequences of clinical fractures of the hip, spine, forearm, shoulder, rib, pelvis and lower leg, was undertaken to identify the 10-year hip fracture probability required for osteoporosis treatment to be cost-effective for cohorts defined by age, sex, and race/ethnicity. A 3% 10-year risk of hip fracture was generally required for osteoporosis treatment to cost less than $60,000 per QALY gained.


Rapid growth of the elderly United States population will result in so many at risk of osteoporosis that economically efficient approaches to osteoporosis care warrant consideration.


A Markov-cohort model of annual United States age-specific incidence of clinical hip, spine, forearm, shoulder, rib, pelvis and lower leg fractures, costs (2005 US dollars), and quality-adjusted life years (QALYs) was used to assess the cost-effectiveness of osteoporosis treatment ($600/yr drug cost for 5 years with 35% fracture reduction) by gender and race/ethnicity groups. To determine the 10-year hip fracture probability at which treatment became cost-effective, average annual age-specific probabilities for all fractures were multiplied by a relative risk (RR) that was systematically varied from 0 to 10 until a cost of $60,000 per QALY gained was observed for treatment relative to no intervention.


Osteoporosis treatment was cost-effective when the 10-year hip fracture probability reached approximately 3%. Although the RR at which treatment became cost-effective varied markedly between genders and by race/ethnicity, the absolute 10-year hip fracture probability at which intervention became cost-effective was similar across race/ethnicity groups, but tended to be slightly higher for men than for women.


Application of the WHO risk prediction algorithm to identify individuals with a 3% 10-year hip fracture probability may facilitate efficient osteoporosis treatment.


Cost-effectiveness National Osteoporosis Foundation Osteoporosis Practice guidelines World Health Organization 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  • A. N. A. Tosteson
    • 1
    • 8
  • L. J. MeltonIII
    • 2
  • B. Dawson-Hughes
    • 3
  • S. Baim
    • 4
  • M. J. Favus
    • 5
  • S. Khosla
    • 6
  • R. L. Lindsay
    • 7
  1. 1.Multidisciplinary Clinical Research Center in Musculoskeletal Diseases and The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth Medical SchoolLebanonUSA
  2. 2.Division of Epidemiology, College of MedicineMayo ClinicRochesterUSA
  3. 3.Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonUSA
  4. 4.The Medical College of WisconsinMilwaukeeUSA
  5. 5.Department of MedicineUniversity of ChicagoChicagoUSA
  6. 6.Division of Endocrinology, College of MedicineMayo ClinicRochesterUSA
  7. 7.Helen Hayes HospitalRegional Bone CenterWest HaverstrawUSA
  8. 8.HB7505 Clinical Research, Dartmouth Medical SchoolLebanonUSA

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