Treatment of established osteoporosis: a systematic review and cost-utility analysis

Kanis J A, Brazier J E, Stevenson M, Calvert N W, Lloyd Jones M
Record ID 32003000418
Authors' objectives:

A variety of agents are available for the treatment of osteoporosis. This review examines the evidence for their efficacy, and their cost-effectiveness is modelled.

Authors' results and conclusions: The results of the systematic review of RCTs indicated that bisphosphonates, calcitonin, calcium, fluoride salts and raloxifene reduced the incidence of vertebral fracture. The bisphosphonate, alendronate, also decreased non-vertebral fracture, including hip fracture. For several agents, failure to demonstrate efficacy, particularly for hip fracture, was largely due to the lack of appropriate RCTs. Epidemiological evidence suggested that treatment with calcium, calcitonin, HRT, thiazide diuretics, etidronate and anabolic steroids decreased hip fracture risk. There was also RCT evidence that calcium plus vitamin D decreased fracture risk in patients for whom BMD was not known.
Authors' recommendations: Cost-effective scenarios for several interventions in the management of established osteoporosis were identified. Cost-effectiveness ratios decrease with age. At age 50 years, only HRT and calcium plus vitamin D were cost-effective (assuming that the agent would decrease the risk of appendicular fractures at this age). At age 80 years, HRT, calcium with or without vitamin D, alfacalcidol, alendronate and bisphosphonate were all cost-effective. The conclusions derived are conservative, mainly because of the assumptions made in the absence of sufficient data. The conservative assumptions included the following: (i) not all osteoporotic fractures are included (ii) not all vertebral fractures are included (iii) base-case scenarios are modelled at the threshold for osteoporosis (iv) risks of re-fracture in the few years after a fracture are likely to be underestimated (v) vertebral fracture incurs no reversible mortality (vi) long-term effects of osteoporotic fractures on utilities are ignored. Thus conclusions that treatments are cost-effective are reasonably secure. In contrast, scenarios shown to be cost-ineffective are less secure. As information in these areas becomes available, the implications on cost-effectiveness of interventions should be reappraised.
Authors' methods: Systematic review, Cost study
Project Status: Completed
URL for project:
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Costs and Cost Analysis
  • Osteoporosis
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name:
Contact Email:
Copyright: 2009 Queen's Printer and Controller of HMSO
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.