Universal bisphosphonates after wrist fracture prevent hip fractures but at a cost


Giving bone-strengthening medication routinely to all elderly women who sustain a wrist fracture would reduce subsequent hip fractures by about a quarter, but at a cost of over $200,000 per prevented fracture. Additionally, expanded bisphosphonate use could cause nearly 20,000 more atypical femur fractures in this population.

Dr. Suneel Bhat and his associates at Thomas Jefferson University, Philadelphia, used sophisticated modeling techniques to project costs and consequences of wider prescribing of bisphosphonates for bone fragility in women aged 65 years and older. Distal radius fracture is known to be associated with osteoporosis in women of this age, who are then at increased risk of subsequent fracture. Dr. Bhat presented his findings on March 24 at the annual meeting of the American Academy of Orthopedic Surgeons in Las Vegas.

Study authors drew from the medical literature and publicly available Medicare data to obtain fracture incidence data and cost information for statistical modeling. Bhat and colleagues obtained age-specific incidence of distal radius fractures among women aged 65 and older, as well as rates of hip fracture following wrist fractures, both for those who did and did not receive the bisphosphonate risendronate. Atypical femur fracture is a known complication of bisphosphonate treatment for some patients; the risk of this complication and medication costs were drawn from the literature.

To assess the direct costs of hip fracture treatment, investigators used Medicare reimbursement data to price treatment components, including inpatient care as well as surgical and anesthesia services.

From these data, investigators used a modified Monte Carlo technique to obtain a cost and incidence model. This model predicted that 357,656 lifetime subsequent hip fractures would occur in elderly women with wrist fracture; this number would drop to 262,767 with universal bisphosphonate treatment. The cost for this savings, an aggregate $19.5 billion in drug costs, meant that each fracture prevented would cost $205,534. An additional 19,464 patients would sustain atypical femur fracture from risendronate treatment.

Average risendronate costs were estimated at $1,485/patient-year. This figure would have to fall to just $70/patient yearly to make risendronate treatment cost effective, Dr. Bhat calculated.



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