Potential for bone turnover markers to cost-effectively identify and select post-menopausal osteopenic women at high risk of fracture for bisphosphonate therapy

J. T. Schousboe, D. C. Bauer, J. A. Nyman, R. L. Kane, L. J. Melton, K. E. Ensrud

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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.

Original languageEnglish (US)
Pages (from-to)201-210
Number of pages10
JournalOsteoporosis International
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2007

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Keywords

  • Bisphosphonates
  • Bone turnover
  • Cost-effectiveness
  • Non-vertebral fracture
  • Vertebral fracture

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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