Cost effectiveness of a targeted intervention to reduce refracture rates: Analysis of a four year prospective controlled study

Abstract

Osteoporotic fractures and lowbonedensity (BMD) are associatedwithmortality risk and antiresorptive treatmentwith reduced re-fracture andmortality risk.Mechanismsdriving these relationships are unclear. The Dubbo Osteoporosis Epidemiology Study explored the relationships between anti-resorptive osteoporosis treatment, bone loss, fracture and mortality risk. Fracture and mortality data were collected from 2042 individuals all aged 60+ (1223 women and 819 men) between 1989 and 2007 with co-morbidities and medication recorded 2-yearly. Of these, 325womenwere onosteoporosis treatment; 106bisphosphonates (BP), 77 hormone therapy (HT) and 142 calcium±vitamin D only (CaD) as were 37men (15 BP, 22 CaD). Among these, there were 226 fractures inwomen and 68 inmen over 15 (IQR: 9–17) and 14 years (IQR: 7–16)with 284 deaths (101 post-fracture) in women and 246 (43 post-fracture) in men. Rate of change of bone density was available in 63% (n=1291). Cox proportional hazards models were used. Higher rates of bone loss were associated with higher mortality; 47% greater in women and 29% in men per 3%/year bone loss. This was largely unchanged by adjusting for fracture and frailty markers. Post-fracture, bone loss ≥1 vs 12months) treatment with TPD is associated with an increase in serum levels of DKK-1 that might be associated with the appearance of TPD's declining pharmacological efficacy. This article is part of a Special Issue entitled ECTS 2011. Disclosure of interest: None declared. doi:10.1016/j.bone.2011.03.090