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Treatment Thresholds for Osteoporosis and Reimbursability Criteria: Perspectives Associated with Fracture Risk-Assessment Tools

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Abstract

The definition of osteoporosis was based for several years on bone mineral density values, which were used by most guidelines for defining treatment thresholds. The availability of tools for the estimation of fracture risk, such as FRAX™ or its adapted Italian version, DeFRA, is providing a way to grade osteoporosis severity. By applying these new tools, the criteria identified in Italy for treatment reimbursability (e.g., “Nota 79”) are confirmed as extremely conservative. The new fracture risk-assessment tools provide continuous risk values that can be used by health authorities (or “payers”) for identifying treatment thresholds. FRAX estimates the risk for “major osteoporotic fractures,” which are not counted in registered fracture trials. Here, we elaborate an algorithm to convert vertebral and nonvertebral fractures to the “major fractures” of FRAX, and this allows a cost-effectiveness assessment for each drug.

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Authors and Affiliations

  1. Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 37134, Verona, Italy

    Silvano Adami, Davide Gatti & Maurizio Rossini

  2. Internal Medicine, University of Verona, Verona, Italy

    Francesco Bertoldo

  3. Rheumatology Unit, G. Pini Hospital, Milan, Italy

    Luigi Sinigaglia & Massimo Varenna

  4. Rheumatology Unit, Ospedale Forlanini, Rome, Italy

    Giovanni Minisola

Authors
  1. Silvano Adami
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  2. Francesco Bertoldo
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  3. Davide Gatti
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  4. Giovanni Minisola
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  5. Maurizio Rossini
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  6. Luigi Sinigaglia
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  7. Massimo Varenna
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Corresponding author

Correspondence to Silvano Adami.

Additional information

This study was conducted on behalf of the Italian Societies for Osteoporosis (SIOMMMS) and Rheumatology (SIR).

The authors have stated that they have no conflict of interest.

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Adami, S., Bertoldo, F., Gatti, D. et al. Treatment Thresholds for Osteoporosis and Reimbursability Criteria: Perspectives Associated with Fracture Risk-Assessment Tools. Calcif Tissue Int 93, 195–200 (2013). https://doi.org/10.1007/s00223-013-9748-0

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  • DOI: https://doi.org/10.1007/s00223-013-9748-0

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