A Cost Effectiveness Analysis of Calcium and Vitamin D Supplementation, Etidronate, and Alendronate in the Prevention of Vertebral Fractures in Women Treated with Glucocorticoids

LENORE M. BUCKLEY and BRUCE E. HILLNER

ABSTRACT.

Objective. To assess the relative costs and benefits of calcium and vitamin D supplements, cyclic etidronate, or alendronate in the prevention of vertebral fractures for women and with normal bone density and osteopenia who are about to initiate moderate dose glucocorticoid treatment.

Methods. Using a decision analysis model, we evaluated the following patients: 4 hypothetical cohorts: 30-yr-old women with normal lumbar spine (LS) bone mineral density (BMD) (t score = 0), 50-yr-old women with borderline osteopenia (t score = -1), 60-yr-old women with moderate osteopenia (t score = -1.5), and 70-yr-old women with severe osteopenia (t score = -2) treated with a mean prednisone dose of 10 mg/day for one year. The main outcomes included the development of vertebral fractures 10 years after glucocorticoid treatment and at age 80 (life-time risk) and direct and indirect costs.

Results. At 10 years, calcium and vitamin D supplements decreased fracture rates by 30-50% at a minimal cost (US$800 or less per vertebral fracture avoided) or at a cost saving compared to no treatment for women with osteopenia (t score -1 to -2). Etidronate and alendronate are most cost effective in women with borderline osteoporosis (t scores of -1.5 and -2) in the 10 year analysis. In the life-time analysis, calcium and vitamin D treatment yielded a cost savings compared to no treatment for all groups with osteopenia. Etidronate decreased fracture rates further in all groups at a cost of less than $2,000 per fracture prevented. Alendronate reduced the fracture risk further at cost of $3,000-7,000 per fracture avoided.

Conclusion. Calcium and vitamin D supplements and low cost bisphosphonate regimens such as cyclic etidronate decrease the life-time vertebral fracture risk at acceptable costs and should be considered when initiating glucocorticoid treatment for women who do not have osteoporosis. (J Rheumatol 2003;30:132-8)

Key Indexing Terms:

CORTICOSTEROIDS
GLUCOCORTICOIDS
OSTEOPOROSIS
BISPHOSPHONATES
CALCIUM
VITAMIN D

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From Virginia Commonwealth University, Richmond, Virginia, USA.

Supported by SmithKline Beecham Consumer Healthcare.

L.M. Buckley, MD MPH, Professor of Internal Medicine and Pediatrics; B.E. Hillner, MD, Professor of Internal Medicine.

Address reprint requests to: Dr. L.M. Buckley, Virginia Commonwealth University, 1200 East Broad Street, Box 980102, Richmond, VA, 23298-0102, USA. E-mail: lbuckley@hsc.vcu.edu

Submitted October 16, 2002; revision accepted May 30, 2002.

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