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Senior Citizen Health & Medicine
Osteoporosis Screening, Treatment May Be
Cost-Effective For Selected Older Men
White men at age 60 have 29% chance of osteoporotic
fracture in lifetime
Aug. 8, 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 the Journal of the American Medical Association.
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.
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