Prevalence and Cost of Subsequent Fractures Among U.S. Patients with an Incident Fracture

Weaver, Jessica; Sajjan, Shiva; Lewiecki, E. Michael; Harris, Steven T.; Marvos, Panagiotis

doi:10.18553/jmcp.2017.23.4.461

Cited by 34 publications

(42 citation statements)

References 16 publications

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“…(3) Consequences of second fractures may include loss of independence, the loss of mobility, and increased mortality. The risk of another broken bone is substantially increased-Medicare patients who had a first fracture of the hip or spine had a 20% to 25% chance of a subsequent fracture just within the first year.…”

Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

“…(1,2) Although one of the reasons for this undertreatment clearly stems from concerns regarding rare side effects of osteoporosis medications, particularly bisphosphonates, other reasons persist as well (eg, discrepancies among treatment guidelines). (3) By focusing its clinical recommendations on secondary prevention, the coalition sought not only to unequivocally target high-risk patients but also to establish a "floor" upon which subsequent treatment strategies could be built. The first, and perhaps most critical, decision the coalition made was to target this effort to a group where there was little controversy that the benefits of treatment almost always outweighed the risks-people aged 65 years or older with a hip or vertebral fracture.…”

Section: Introductionmentioning

confidence: 99%

“…The first, and perhaps most critical, decision the coalition made was to target this effort to a group where there was little controversy that the benefits of treatment almost always outweighed the risks-people aged 65 years or older with a hip or vertebral fracture. (3) By focusing its clinical recommendations on secondary prevention, the coalition sought not only to unequivocally target high-risk patients but also to establish a "floor" upon which subsequent treatment strategies could be built. The following recommendations are unique in the field because they were developed and supported by professionals from all segments of the osteoporosis treatment community and provide a workable base for building future consensus.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

167

111

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Osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first‐line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). © 2019 American Society for Bone and Mineral Research.

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Section: Additional Recommendations and Rationalesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley

Adib²,

Adler

et al. 2019

Journal of Bone and Mineral Research

167

111

View full text Add to dashboard Cite

show abstract

“…We also incorporated a higher cost for a recurrent fracture at the same type within the model, in line with a recent study suggesting that patients who experienced a subsequent fracture had significantly higher healthcare costs than patients with a first fracture [26]. The proportion factor (1.68) derived from the study of Weaver et al [26] was thus applied.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of gastro-resistant risedronate tablets for the treatment of postmenopausal women with osteoporosis in France

Hiligsmann

Reginster

2019

Osteoporos Int

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SummaryThe use of gastro-resistant risedronate, a convenient dosing regimen for oral bisphosphonate therapy, seems a cost-effective strategy compared with weekly alendronate, generic risedronate, and no treatment for the treatment of postmenopausal women with osteoporosis in France.IntroductionGastro-resistant (GR) risedronate tablets are associated with improved persistence compared to common oral bisphosphonates but are slightly more expensive. This study assessed its cost-effectiveness compared to weekly alendronate and generic risedronate for the treatment of postmenopausal women with osteoporosis in France.MethodsA previously validated Markov microsimulation model was used to estimate the lifetime costs (expressed in €2017) per quality-adjusted life-years (QALY) of GR risedronate compared with weekly alendronate, generic risedronate, and no treatment. Pooled efficacy data for bisphosphonates derived from a previous meta-analysis were used for all treatment options, and persistence data (up to 3 years) were obtained from a large Australian longitudinal study. Evaluation was done for high-risk women 60–80 years of age, with a bone mineral density (BMD) T-score ≤ − 2.5 and/or prevalent vertebral fractures.ResultsIn all of the simulated populations, GR risedronate was cost-effective compared to alendronate, generic risedronate, and no treatment at a threshold of €60,000 per QALY gained. In women with a BMD T-score ≤ − 2.5 and prevalent vertebral fractures, the cost per QALY gained of GR risedronate compared to alendronate, generic risedronate, and no treatment falls below €20,000 per QALY gained. In women aged 75 years and older, GR risedronate was even shown to be dominant (more QALYs, less costs) compared to alendronate, generic risedronate, and no treatment.ConclusionThis study provides the first economic results about GR risedronate, suggesting that it represents a cost-effective strategy compared with weekly alendronate and generic risedronate for the treatment of postmenopausal women with osteoporosis in France.

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“…The serum creatinine-to-cystatin C ratio (Cr/CysC) is in focus as a sarcopenia marker because it represents total muscle volume. Recently, Cr/CysC was suggested to have correlation with bone fragility fracture risk [1]. Objectives: This study aimed to assess whether Cr/CysC is correlated with BMD.…”

mentioning

confidence: 99%

Ab0859 the Serum Creatinine to Cystatin C Ratio; A Possible New Surrogate Marker for Bone Mineral Density

Yoshii¹,

Chijiwa²,

Sawada

2019

Abstracts Accepted for Publication

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BackgroundBone mineral density (BMD) measured using dual-energy X-ray absorptiometry (DEXA) is one of the most important markers for osteoporosis diagnosis. The serum creatinine-to-cystatin C ratio (Cr/CysC) is in focus as a sarcopenia marker because it represents total muscle volume. Recently, Cr/CysC was suggested to have correlation with bone fragility fracture risk [1].ObjectivesThis study aimed to assess whether Cr/CysC is correlated with BMD.MethodsBMD at the lumbar spine (LS) and femoral neck (FN) were measured in women diagnosed with postmenopausal osteoporosis. Steroid induced osteoporosis patients were eliminated. Cr/CysC was assessed at the time. Clinical factors, such as age, concurrent rheumatoid arthritis treatment (RA), concomitant biological drug administration (BIO), body mass index (BMI), concurrent dementia treatment (dementia), number of comorbidities other than dementia (N.Com), frailty score (FS), bone fragility fracture (BFF), and drug intervention for osteoporosis (DI), were evaluated. Multivariate linear regression (MLR) was used to assess the correlation of these factors with BMD at each part. The relationships between Cr/CysC and other parameters were statistically evaluated using MLR. Additionally, the relationships between the BMD change at each part and parameters were evaluated in the same manner.ResultsThe study enrolled 207 subjects. BMD at the LS was significantly correlated with BMI and N.Com (p<0.01), whereas BMD at the FN was significantly negatively correlated with age and was positively correlated with BMI, BFF, Cr/CysC, and DI (p<0.01). Cr/CysC was significantly correlated with age, RA, BIO, dementia, FS, and BFF (p<0.01).After effect of age was corrected, BMD at the FN demonstrated significant positive correlation with Cr/CysC (p<0.01), whereas no statistical correlation demonstrated between BMD at the LS and Cr/CysC, Both BMD at the LS and the FN demonstrated significant positive correlation with BMI (p<0.05). No parameter significantly correlated with the BMD change at both the LS and FN (p<0.01).Table: Results of multivariate linear regression analysis for relationship between BMD in each part and parametersunivariate modemultivariate modeparametersCoefficientLCLUCLp-valueCoefficientLCLUCLp-valueage-0.002-0.0052.0x10-3 0.078 RA0.0650.0170.1149.00x10-4 0.034-0.0170.0840.19BIO0.036-0.0370.1090.338 BMI0.0180.0120.0243.54x10-8 0.0190.0130.0252.60x10-9 N.Com0.0080.0120.3456.70x10-6 0.010.0530.0143.00x10-5 Dementia-0.009-0.0620.0460.757Frailty score-0.015-0.0319.0x10-3 0.065bone fragility fracture-0.051-0.1080.0050.073 Cr/CysC0.2030.0062.0280.0440.086-0.110.2830.39Drug intervention-0.042-0.1030.0190.18 age-0.004-0.006-5.6415.72x10-8 -0.003-0.001-3.2131.55x10-3 RA0.0650.0340.0954.00x10-6 0.025-0.010.0590.16 BIO0.0590.0140.1050.0110.001-0.0490.0510.98 BMI0.0043.0x10-4 0.0080.0480.0042.0x10-3 0.0080.037N.Com0.0020.0051.130.26 Dementia-0.049-0.083-0.0154.78x10-3 0.008-0.0290.0440.69 Frailty score-0.019-0.028-0.0092.60x10-5 0.005-0.0070.0170.44 bone fragility fracture-0.068-0.103...

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Prevalence and Cost of Subsequent Fractures Among U.S. Patients with an Incident Fracture

Cited by 34 publications

References 16 publications

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Cost-effectiveness of gastro-resistant risedronate tablets for the treatment of postmenopausal women with osteoporosis in France

Ab0859 the Serum Creatinine to Cystatin C Ratio; A Possible New Surrogate Marker for Bone Mineral Density

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