Osteoporosis Screening and Treatment May Be Cost-Effective for Some Older Men

One-third of all hip fractures occur in men and are linked with as much illness and increased risk of death than those that occur in women. In spite 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., from Park Nicollet Health Services (Minneapolis, MN, USA), and colleagues conducted a study to estimate the lifetime costs and health benefits of bone densitometry (measurement of bone density) followed by five years of oral bisphosphonate (a class of drugs used to strengthen bone) therapy for men found to have osteoporosis. They reported their findings in the August 8, 2007, issue of the Journal of the American Medical Association (JAMA).

The researchers devised a computer simulation model for hypothetical groups of white men of 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 investigators 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 revealed that the estimated prevalence of femoral neck osteoporosis among men with a prior fracture ranged from 14.5% at age 65 years to 33.6% at age 85 years. Osteoporosis prevalence in the absence of a prior clinical fracture was lower, ranging from 7.6% at age 65 years to 17.6% at age 85 years. The densitometry and treatment strategy slightly reduced the absolute 10-year incidence of clinical fractures by a range of 2.1% for 65-year-old men without a prior fracture to 4.5% among 85-year-old men with a prior fracture.

Regarding cost-effectiveness, the researchers reported in their article, 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.


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