Osteoporosis screening and treatment may be cost-effective for selected older men

August 07, 2007

It may be cost-effective to screen and treat selected older men with osteoporosis, depending on their age and if they have had a prior fracture, according to a study in the August 8 issue of JAMA.

Osteoporotic fractures are recognized as a common and serious health problem among elderly men, with white men at age 60 years having a 29 percent chance of experiencing such a fracture during their remaining lifetime, according to background information in the article. One-third of all hip fractures occur in men and are associated with as much illness and increased risk of death than those that occur in women. Despite the importance of the problem of osteoporosis in men, there is a lack of evidence regarding the cost-effectiveness of common diagnostic and therapeutic interventions.

John T. Schousboe, M.D., M.S., of Park Nicollet Health Services, Minneapolis, and colleagues conducted a study to estimate the lifetime costs and health benefits of bone densitometry (measurement of bone density) followed by 5 years of oral bisphosphonate (a class of drugs used to strengthen bone) therapy for men found to have osteoporosis. The researchers created a computer simulation model for hypothetical groups of white men age 65, 70, 75, 80, or 85 years, with or without prior clinical fracture. Data from several sources were used to estimate fracture costs and population-based age-specific fracture rates and associations among prior fractures, bone density and incident fractures. The authors estimated the costs per quality-adjusted life-years (QALYs) gained for the densitometry and follow-up treatment strategy compared with no intervention, calculated from lifetime costs and accumulated QALYs for each strategy.

The researchers found that the estimated prevalence of femoral neck osteoporosis among men with a prior fracture ranged from 14.5 percent at age 65 years to 33.6 percent at age 85 years. Osteoporosis prevalence in the absence of a prior clinical fracture was lower, ranging from 7.6 percent at age 65 years to 17.6 percent at age 85 years. The densitometry and treatment strategy modestly reduced the absolute 10-year incidence of clinical fractures by a range of 2.1 percent for 65-year-old men without a prior fracture to 4.5 percent among 85-year-old men with a prior fracture.

Regarding cost-effectiveness, "universal bone densitometry followed by oral bisphosphonate therapy among those found to have osteoporosis for all men aged 70 years or older regardless of fracture history or other fracture risk factors is not cost-effective using current drug costs. However, this strategy may be cost-effective for men aged 65 years or older with a prior clinical fracture and for men aged 80 years or older without a prior fracture, assuming a societal willingness to pay per QALY gained of $50,000. This densitometry and treatment strategy may also be cost-effective for white men aged 70 years or older without a prior clinical fracture if the cost of oral bisphosphonate therapy is less than $500 per year or if the societal willingness to pay per QALY gained is $100,000."
-end-
(JAMA. 2007;298(6):629-637. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For More Information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA or email: mediarelations@jama-archives.org.

The JAMA Network Journals

Related Osteoporosis Articles from Brightsurf:

New opportunities for detecting osteoporosis
Osteoporosis can be detected through low dose computed tomography (LDCT) imaging tests performed for lung cancer screening or other purposes.

Oxytocin can help prevent osteoporosis
In a laboratory experiment with rats, Brazilian researchers succeeded in reversing natural processes associated with aging that lead to loss of bone density and strength.

New strategy against osteoporosis
An international research team has found a new approach that may be able to reduce bone loss in osteoporosis and maintain bone health.

New review on management of osteoporosis in premenopausal women
An IOF and ECTS Working Group have published an updated review of literature published after 2017 on premenopausal osteoporosis.

Cardiac CT can double as osteoporosis test
Cardiac CT exams performed to assess heart health also provide an effective way to screen for osteoporosis, potentially speeding treatment to the previously undiagnosed, according to a new study.

Osteoporosis treatment may also protect against pneumonia
A recent study published in the Journal of Bone and Mineral Research found that nitrogen-containing bisphosphonates (N-BPs) such as alendronate, which are widely used to treat postmenopausal osteoporosis, are linked with lower risks of pneumonia and of dying from pneumonia.

New pharmaceutical target reverses osteoporosis in mice
Biomedical engineers at Duke University have discovered that an adenosine receptor called A2B can be pharmaceutically activated to reverse bone degradation caused by osteoporosis in mouse models of the disease.

A link between mitochondrial damage and osteoporosis
In healthy people, a tightly controlled process balances out the activity of osteoblasts, which build bone, and osteoclasts, which break it down.

Many stroke patients not screened for osteoporosis, despite known risks
Many stroke survivors have an increased risk of osteoporosis, falls or breaks when compared to healthy people.

Many postmenopausal women do not receive treatment for osteoporosis
The benefits of treating osteoporosis in postmenopausal women outweigh the perceived risks, according to a Clinical Practice Guideline issued today by the Endocrine Society.

Read More: Osteoporosis News and Osteoporosis Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.