Cost-effectiveness strategies to treat osteoporosis in elderly women

South Med J. 2006 Feb;99(2):123-31. doi: 10.1097/01.smj.0000202090.30647.61.


Background: Comparing the cost-effectiveness of various antiosteoporotic drugs has not been defined.

Methods: We determined the cost-effectiveness of calcitonin, raloxifene, bisphosphates and PTH in a base-case cohort of women aged 65 or older with osteoporosis. After bone densitometry, women were stratified into groups of treatment or no treatment. Our outcome goal was a value of dollars 100,000 or less per quality-adjusted life years (QALY). A sensitivity analysis varied nonvertebral fracture reduction and compliance between the two most effective strategies to test various cost per QALY thresholds.

Results: Bisphosphonates displayed the most favorable incremental cost saving and prevented more fractures in our base-case analysis. In a sensitivity analysis, virtually all values of bisphosphonates were under dollars 100,000 per QALY and parathyroid hormone (PTH) was between dollars 100,000 and dollars 200,000 per QALY.

Conclusions: Only bisphosphonates are cost-effective for fracture prevention in osteoporotic women aged 65 or older and this economic advantage is also maintained in subsets who have a lower relative risk of future fracture.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Density Conservation Agents / economics*
  • Bone Density Conservation Agents / therapeutic use
  • Calcitonin / economics
  • Calcitonin / therapeutic use
  • Cost Savings / economics
  • Cost-Benefit Analysis
  • Diphosphonates / economics
  • Diphosphonates / therapeutic use
  • Female
  • Fractures, Bone / economics
  • Fractures, Bone / etiology
  • Fractures, Bone / prevention & control
  • Humans
  • Osteoporosis / complications
  • Osteoporosis / drug therapy
  • Osteoporosis / economics*
  • Parathyroid Hormone / economics
  • Parathyroid Hormone / therapeutic use
  • Quality of Life
  • Raloxifene Hydrochloride / economics
  • Raloxifene Hydrochloride / therapeutic use
  • Treatment Outcome


  • Bone Density Conservation Agents
  • Diphosphonates
  • Parathyroid Hormone
  • Raloxifene Hydrochloride
  • Calcitonin