Cost-effectiveness of personalized supplementation with vitamin D-rich dairy products in the prevention of osteoporotic fractures

Abstract

SummaryTitrated supplementations with vitamin D-fortified yogurt, based on spontaneous calcium and vitamin D intakes, can be cost-effective in postmenopausal women with or without increased risk of osteoporotic fractures.IntroductionThe objective of this study is to assess the cost-effectiveness of the vitamin D-fortified yogurt given to women with and without an increased risk of osteoporotic fracture.MethodsA validated cost-effectiveness microsimulation Markov model of osteoporosis management was used. Three personalized supplementation scenarios to reflect the Ca/Vit D needs taking into account the well-known variations in dietary habits and a possible pharmacological supplementation in Ca/Vit D, given above or in combination with anti-osteoporosis medications: one yogurt per day, i.e., 400 mg of Ca + 200 IU of Vit D (scenario 1 U), two yogurts per day, i.e., 800 mg of Ca + 400 IU of Vit D (scenario 2 U), or three yogurts per day, i.e., 1,200 mg of Ca + 600 IU of Vit D (scenario 3 U).ResultsOne yogurt is cost-effective in the general population above the age of 70 years and in all age groups in women with low bone mineral density (BMD) or prevalent vertebral fracture (PVF). The daily intake of two yogurts is cost-effective above 80 years in the general population and above 70 years in the two groups of women at increased risk of fractures. However, an intake of three yogurts per day is only cost-effective above 80 years old in the general population, as well as in women with low BMD or PVF.ConclusionsOur study is the first economic analysis supporting the cost-effectiveness of dairy products, fortified with vitamin D, in the armamentarium against osteoporotic fractures.

Public health impact and economic evaluation of vitamin D-fortified dairy products for fracture prevention in France

“…Similarly, Ethgen et al also showed that the intake of dairy products is cost-effective in the general population over 70 years in Belgium [31]. Our study is more conservative as we did not incorporate any treatment effect after the year of the intake of fortified dairy products.…”

Calcium supplementation in osteoporosis: useful or harmful?

“…The fact that at bone level the type 1 collagen matrix is strengthened with the apposition of calcium hydroxyapatite crystals supports the idea that an adequate calcium status is crucial for bone health (13). The dietary calcium intake may be adequate in most individuals, but, there is evidence that in subjects with inadequate calcium and vitamin D intake, the supplementation strategies are useful for preventing osteoporosis related fragility fractures (14,15). Indeed, in the presence of inadequate calcium intake and/or vitamin D production, the latter being fundamental for a proper intestinal calcium absorption, the incipient hypocalcemia leads to a secondary Page 3 of 32 hyperparathyroidism, increased bone turnover, bone loss and increased facture risk (16).…”

Phase IV randomized preference study in patients eligible for calcium and vitamin D supplementation

“…Indeed, vitamin D-fortified yogurt given to women with and without an increased risk of osteoporotic fracture is cost-effective in the treatment of osteoporotic fractures in the elderly population 19 . The recommendation to use dairy products as the preferred source of calcium and vitamin D in aging males and females is supported by public health and health economic analyses 20 .…”