From the Guidelines
Osteoporotic fractures among postmenopausal women have substantial economic impacts, costing healthcare systems billions annually through direct medical expenses and indirect costs, with the yearly number of fractures projected to increase from 1.9 million in 2018 to over 3.2 million fractures by 2040, and direct medical costs increasing from $48.8 billion to $81.5 billion during the same time range 1. The economic burden of osteoporotic fractures extends beyond the healthcare system to include social services, disability payments, and home modifications.
- The average cost of treating a hip fracture ranges from $10,000 to $50,000 in the first year alone, with additional expenses for subsequent years.
- Indirect economic consequences include lost productivity for both patients and caregivers, with many women unable to return to previous employment or requiring family members to reduce work hours to provide care. Prevention strategies such as bisphosphonates (alendronate 70mg weekly or risedronate 35mg weekly), denosumab (60mg subcutaneously every 6 months), or teriparatide (20mcg daily injection for up to 24 months) are cost-effective interventions that can significantly reduce fracture risk and associated costs, as supported by recent guidelines 1.
- Early bone density screening for postmenopausal women, particularly those with risk factors, and calcium (1000-1200mg daily) and vitamin D (800-1000 IU daily) supplementation can help identify and treat osteoporosis before costly fractures occur. It is essential to consider the cost-effectiveness of osteoporosis interventions, including pharmacologic therapy and screening strategies, to substantially reduce osteoporosis-associated morbidity and mortality, as highlighted in a recent systematic review 1.
- The cost-effectiveness of medications, such as oral bisphosphonates and denosumab, has been proven in preventing fractures in high-risk populations.
- Screening for osteoporosis using dual-energy X-ray absorptiometry (DXA) can be cost-effective in preventing fractures, particularly in men who have sustained a fall or have a history of fracture.
From the Research
Economic Impacts of Osteoporotic Fractures
- Osteoporotic fractures among postmenopausal women result in substantial economic burdens, with millions of fractures occurring each year, placing a significant economic burden of billions of dollars from Medicare alone 2.
- The direct medical costs and loss of quality of life due to osteoporotic fractures are substantial, making the cost-effectiveness of interventions to reduce the incidence of fractures highly significant to large-scale health insurers and healthcare systems 3.
- Interventions aimed at improving fracture risk assessment and adherence to treatments can relieve the burden of osteoporosis, with a combination strategy achieving the greatest benefits, including a decrease of 17.9% in fractures and 15.2% in costs 4.
Cost-Effectiveness of Pharmacologic Therapy
- Most modeling studies suggest that oral bisphosphonates and raloxifene are cost-effective therapies for preventing osteoporotic fractures in postmenopausal women, particularly those selected on the basis of bone mineral density and/or prevalent vertebral fracture 3.
- Increasingly, modeling studies are being done to establish absolute fracture risk thresholds at which various treatments are cost-effective, including those selected on the basis of absolute fracture risk rather than bone density criteria 3.
Burden of Osteoporosis
- Osteoporosis is associated with significant clinical and economic burden, expected to further increase with an ageing population, with a predicted 44% increase in the annual number of fractures and costs from 2020 to 2040 4.
- The lifetime fracture risk at 50 years of age is about 50% in women, making osteoporosis a major public health concern 5.