title: Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective?
abstract: To determine the age- and BMD-specific burden of fractures in the community and the cost-effectiveness of targeted drug therapy, we studied a demographically well-categorized population with a single main health provider. Of 1224 women over 50 years of age sustaining fractures during 2 years, the distribution of all fractures was 11%, 20%, 33%, and 36% in those aged 50-59, 60-69, 70-79, and 80+ years, respectively. Osteoporosis (T score < -2.5) was present in 20%, 46%, 59%, and 69% in the respective age groups. Based on this sample and census data for the whole country, treating all women over 50 years of age in Australia with a drug that halves fracture risk in osteoporotic women and reduces fractures in those without osteoporosis by 20%, was estimated to prevent 18,000 or 36% of the 50,000 fractures per year at a total cost of $573 million (AUD). Screening using a bone mineral density of T score of -2.5 as a cutoff, misses 80%, 54%, 41%, and 31% of fractures in women in the respective age groups. An analysis of cost per averted fracture by age group suggests that treating women in the 50- to 59-year age group with osteoporosis alone costs $156,400 per averted fracture. However, in women aged over 80 years, the cost per averted fracture is $28,500. We infer that treating all women over 50 years of age is not feasible. Using osteoporosis and age (>60 years) as criteria for intervention reduces the population burden of fractures by 28% and is cost-effective but solutions to the prevention of the remaining 72% of fragility fractures remain unavailable.
authors.affiliation: Department of Clinical and Biomedical Sciences, Barwon Health, The University of Melbourne, PO Box 281, Geelong 3220, Australia. kerrie@barwonhealth.org.au
authors.forename: Kerrie M
authors.initials: KM
authors.lastname: Sanders
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Nicholson
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Watts
authors.forename: Julie A
authors.initials: JA
authors.lastname: Pasco
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Henry
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kotowicz
authors.forename: Ego
authors.initials: E
authors.lastname: Seeman
mesh_terms: D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005260:Female; D050723:Fractures, Bone / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology