Cost-effectiveness of bone densitometry among Caucasian women and men without a prior fracture according to age and body weight

Summary

We used a microsimulation model to estimate the threshold body weights at which screening bone densitometry is cost-effective. Among women aged 55–65 years and men aged 55–75 years without a prior fracture, body weight can be used to identify those for whom bone densitometry is cost-effective.

Introduction

Bone densitometry may be more cost-effective for those with lower body weight since the prevalence of osteoporosis is higher for those with low body weight. Our purpose was to estimate weight thresholds below which bone densitometry is cost-effective for women and men without a prior clinical fracture at ages 55, 60, 65, 75, and 80 years.

Methods

We used a microsimulation model to estimate the costs and health benefits of bone densitometry and 5 years of fracture prevention therapy for those without prior fracture but with femoral neck osteoporosis (T-score?≤??2.5) and a 10-year hip fracture risk of ≥3%. Threshold pre-test probabilities of low BMD warranting drug therapy at which bone densitometry is cost-effective were calculated. Corresponding body weight thresholds were estimated using data from the Study of Osteoporotic Fractures (SOF), the Osteoporotic Fractures in Men (MrOS) study, and the National Health and Nutrition Examination Survey (NHANES) for 2005–2006.

Results

Assuming a willingness to pay of $75,000 per quality adjusted life year (QALY) and drug cost of $500/year, body weight thresholds below which bone densitometry is cost-effective for those without a prior fracture were 74, 90, and 100 kg, respectively, for women aged 55, 65, and 80 years; and were 67, 101, and 108 kg, respectively, for men aged 55, 75, and 80 years.

Conclusions

For women aged 55–65 years and men aged 55–75 years without a prior fracture, body weight can be used to select those for whom bone densitometry is cost-effective.     

10-Jahres-Ergebnisse nach Durom-Cup-Oberflächenersatz des proximalen Humerus bei Patienten mit rheumatoider Arthritis

Background

Little is known about the long-term results of shoulder arthroplasty in patients with rheumatoid arthritis (RA). The goal of the present study was the clinical and radiological evaluation of a cemented resurfacing of the humeral head in patients with RA after a minimum follow-up of 10 years.

Patients and methods

From 1997–2000 a total of 42 cemented humeral head resurfacing hemi-arthroplasties were performed in 35 patients with RA (average age 61 years) and included in a prospective long-term observational study with follow-up evaluations at 3, 12, >?60 and >?120 months postoperatively. At an average of 131?±?21 months 16 shoulders (14 patients, average age 70.9 years) could be evaluated by the Constant Murley score (CMS) and standard radiographs. For seven patients who were unable to attend hospital a CMS self-evaluation form was used and X-rays were made elsewhere and sent for analysis.

Results

The average total CMS was 62.6?±?10.6 points (pre-operative 20.8?±?8.3 points) and 88?% of the patients were satisfied or very satisfied with the results. Radiographically, a progressive proximal migration of the center of rotation and a continuous increase of the glenoid depth were observed between 3 and 130 months post-operatively. However, the radiographic progression did not correlate with either CMS values or with patient satisfaction.

Conclusions

The cemented humeral head resurfacing as a hemi-arthroplasty represents a valuable option for the treatment of advanced shoulder RA in elderly patients.