Potential for bone turnover markers to cost-effectively identify and select post-menopausal osteopenic women at high risk of fracture for bisphosphonate therapy |
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Authors: | J T Schousboe D C Bauer J A Nyman R L Kane L J Melton K E Ensrud |
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Institution: | (1) Park Nicollet Health Services, 3800 Park Nicollet Blvd, Minneapolis, MN 55416, USA;(2) Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA;(3) Department of Medicine, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA;(4) Clinical Outcomes Research Center, University of Minnesota, Minneapolis, MN, USA;(5) Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;(6) Department of Medicine, Minneapolis VAMC, Minneapolis, MN, USA;(7) Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN, USA |
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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. |
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Keywords: | Bisphosphonates Bone turnover Cost-effectiveness Non-vertebral fracture Vertebral fracture |
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