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Abstract
Osteoporosis is a debilitating disease that results in nearly 1.3 million fractures
per year in the United States. The cost of treating these fractures has been estimated
to be as high as $10 billion per year. These costs are expected to more than double
during the next 50 years unless comprehensive programs of prevention and treatment
are initiated. Both pharmacologic and nonpharmacologic interventions (eg, diet and
exercise) have been shown to have a significant impact on the incidence of osteoporosis,
depending on the time of their application. Unfortunately, osteoporosis is often not
diagnosed until after fractures have occurred, when it may be too late for treatment
to have a major impact. To be most effective, therapy should be started early, before
serious bone loss has occurred. Because of its efficacy and relatively low acquisition
cost, long-term hormone replacement therapy (HRT) is considered first-line pharmacologic
therapy for the prevention of osteoporosis. However, for various reasons, less than
25% of US women who might benefit from HRT are receiving it. Aside from HRT, the only
other products approved by the US Food and Drug Administration for the treatment of
osteoporosis are salmon calcitonin and alendronate. Several other agents are under
development, including sustained-release fluoride and other products in the bisphosphonate
class. The development and adoption of early detection programs and treatment guidelines
are crucial to help ease the economic burden of osteoporosis. These guidelines should
incorporate preventive measures such as diet and exercise, risk assessment through
proper screening programs, and the appropriate use of pharmaceutical products. The
purpose of this paper is to discuss relevant economic issues associated with osteoporosis
and discuss the need for a management algorithm that could be used to more efficiently
prevent and treat this disease. We conclude that further modeling is needed to determine
which programs and treatments are most cost-effective within each at-risk subgroup.
As clinicians better understand the need for preventive care and the advantages of
the various pharmacologic therapies, patients with osteoporosis will receive higher-quality
and more efficient medical care.
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