Osteoporosis Screening May Pay for Selected Older Men

MINNEAPOLIS, Aug. 7 -- It may be cost-effective to screen for and treat osteoporosis in men between the ages of 65 and 80 who've already had a vertebral or hip fracture, researchers reported.
Bone densitometry followed by bisphosphonate therapy for those with osteoporosis may also be cost-effective for men 80 or older who haven't had a previous fracture, said John T. Schousboe, M.D., of Park Nicollet Health Services here, and colleagues, in the Aug. 8 issue of the Journal of the American Medical Association.
That assumes society is willing to pay $50,000 per quality-adjusted life-year gained, the researchers said.
The strategy might also be worth it for fracture-free men as young as 70, depending on the cost of the oral bisphosphonate therapy and the amount society is willing to pay per quality-adjusted life-year (QALY) gained, they said.
Their calculations were especially sensitive to the cost of bisphosphonate therapy, which might change in the future, the researchers noted.
Societal costs worked into the cost-effectiveness analysis included Medicare and other insurance costs, long-term care, nursing-home use, direct and indirect medical costs, and indirect costs such as loss of productivity.
Although osteoporotic fractures among men are associated with as much illness and higher mortality rates as fractures among women, there is little evidence on the cost-effectiveness of common diagnostic and therapeutic interventions for older men, the researchers wrote.
To estimate the lifetime costs and health benefits of bone densitometry followed by five years of oral bisphosphonate therapy for men with osteoporosis, the researchers created a computer simulation model for hypothetical groups of white men ages 65, 70, 80, or 85 with or without a prior clinical fracture.
Data sources for the model parameters included the Rochester Epidemiology Project for fracture costs and population-based age-specific fracture rates, the Osteoporotic Fractures in Men (MrOS) study, meta-analyses, and other published studies.
The data from several sources were used to estimate fracture costs and population-based age-specific fractures rates and associations among prior fractures, bone density, and incident fractures.
The researchers calculated the estimated costs per quality-adjusted life-years (QALY) gained for bone densitometry and follow-up treatment compared with no intervention calculated from life-time costs and accumulated quality-adjusted life-years gained for each strategy.
They found that the estimated prevalence of femoral neck osteoporosis (T score ≤ -2.5) ranged from 14.5% at age 65 to 33.6% at age 85.
Osteoporosis in the absence of a prior fracture was lower, ranging from 7.6% at age 65 to 17.6% at age 85.
Treatment reduced the 10-year incidence of clinical fractures by a range of 2.1% for men age 65 without a prior fracture to 4.5% for men age 85 with a prior fracture.
Based on their analysis, Dr. Schousboe said, universal bone densitometry followed by oral bisphosphonate therapy for all men 70 or older with osteoporosis regardless of fracture history or other fracture risk factors is not cost-effective on the basis of current drug costs.
Although, he noted, intervention may be cost-effective for men 70 or older without a history of fracture if the cost of therapy is less than $500 per year or if society is willing to pay $100,000 per quality-adjusted life-year gained.
Among all the best-case scenarios, the maximum gain in life-years was 2.5 days, they calculated.
They also noted that, alendronate (Fosamax) will lose patent protection in the U.S. in 2008, so the cost of oral bisphosphonate therapy in the near future may be much less than the current U.S. wholesale price.
Important study limitations acknowledged by the researchers were treatment duration of only five years, which tended to limit cost-effectiveness, and results that may not apply to other skeletal sites. Also, they said, the results apply only to white men in the U.S.
Importantly, the researchers said, there are no precise estimates of oral bisphosphonates on nonvertebral fracture among elderly men.
Dr. Schousboe reported receiving research support from Hologic Inc., and serving as a consultant to Eli Lilly, Merck, and Amgen. Other authors reported serving as consultants or receiving grants, research support, or honoraria from Novartis, Amgen, Procter & Gamble, Merck, Pfizer, Lilly, Zelos, Aventis, GlaxoSmithKline, Solvay, and Bionovo.
The MrOS study, which was used to derive certain model parameters, was supported by National Institutes of Health funding under grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Aging, and the National Center for Research Resources.Additional source: Journal of the American Medical AssociationSource reference: Schousboe JT, et al "Cost-effectiveness of Bone Densitometry Followed by Treatment of Osteoporosis in Older Men" JAMA 2007; 298:629-637.