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The cost-effectiveness of osteoporosis medications for preventing periprosthetic fractures following femoral neck fracture indicated hip arthroplasty: a break-even analysis

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Abstract

Summary

Osteoporosis treatment following arthroplasty for femoral neck fracture (FNF) is associated with lower rates of periprosthetic fracture (PPF). Our study evaluated the economic viability of treatment in patients following arthroplasty and demonstrates that treatment with oral bisphosphonates can be cost-effective in preventing PPF.

Introduction

Osteoporosis treatment following arthroplasty for femoral neck fracture (FNF) is associated with lower rates of periprosthetic fracture (PPF). Although cost-effective in reducing the rate of secondary fragility fracture, the economic viability of osteoporosis treatment in preventing PPF has not been evaluated. Therefore, the purpose of this study is to use a break-even analysis to determine whether and which current osteoporosis medications are cost-effective in preventing PPF following arthroplasty for FNFs.

Methods

Three-year average cost of osteoporosis medication (oral bisphosphonates, estrogen hormonal therapy, intravenous (IV) bisphosphonates, denosumab, teriparatide, and abaloparatide), costs of PPF care, and PPF rates in patients who underwent hip arthroplasty for FNFs without osteoporosis treatment were used to perform a break-even analysis. The absolute risk reduction (ARR) related to osteoporosis treatment and sensitivity analyses were used to evaluate the cost-effectiveness of this intervention and break-even PPF rates.

Results

Oral bisphosphonate therapy following arthroplasty for hip fractures would be economically justified if it prevents one out of 56 PPFs (ARR, 1.8%). Given the current cost and incidence of PPF, overall treatment can only be economically viable for PPF prophylaxis if the 3-year costs of these agents are less than $1500.

Conclusion

The utilization of lower cost osteoporosis medications such as oral bisphosphonates and estrogen hormonal therapy as PPF prophylaxis in this patient population would be economically viable if they reduce the PPF rate by 1.8% and 1.5%, respectively. For IV bisphosphonates and newer agents to be economically viable as PPF prophylaxis in the USA, their costs need to be significantly reduced.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA

    Amil R. Agarwal & Amy Y. Zhao

  2. Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Matthew J. Kinnard

  3. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Christopher Murdock, Uzoma Ahiarakwe, Kendall F. Moseley & Savyasachi C. Thakkar

  4. Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PD, USA

    Jordan S. Cohen

  5. Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA

    Gregory J. Golladay

Authors
  1. Amil R. Agarwal
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  2. Matthew J. Kinnard
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  3. Christopher Murdock
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  9. Savyasachi C. Thakkar
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Corresponding author

Correspondence to Amy Y. Zhao.

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Conflicts of interest

Agarwal: none; Kinnard: none; Murdock: none; Zhao: none; Ahiarakwe: none; Cohen: none; Moseley: none; Golladay: board member for the American Association of Hip and Knee Surgeons, editorial or governing board of Arthroplasty Today, Journal of Arthroplasty, board member of Virginia Orthopaedic Society, Royalties from Stryker; Thakkar: committee member for the American Association of Hip and Knee Surgeons, editorial or governing board of Arthroplasty Today, Journal of Arthroplasty, unpaid consultant for KCI, OrthAlign.

Additional information

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Agarwal, Kinnard, Murdock, Zhao, Ahiarakwe, Cohen, Mosely, Golladay, Thakkar.

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Agarwal, A.R., Kinnard, M.J., Murdock, C. et al. The cost-effectiveness of osteoporosis medications for preventing periprosthetic fractures following femoral neck fracture indicated hip arthroplasty: a break-even analysis. Osteoporos Int (2024). https://doi.org/10.1007/s00198-024-07085-6

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