Postmenopausal Osteoporosis

ABSTRACT

Purpose: Postmenopausal osteoporosis (PMO) is a significant health and economic burden on the U.S. Costs related to are approximately $14 billion per year, driven primarily by fractures. We undertook a review of clinical trial and pharmacoeconomic literature related to PMO to summarize efficacy and cost-effectiveness data for current and future pharmaceutical treatment options.

Methods: We searched Medline, International Pharmaceutical Abstracts, Business Source Premier, and Research Digest (published by the International Society for Pharmacoeconom-ics and Outcomes Research) for articles from 1995 to 2006 using osteoporosis-related terms. We selected articles for review if they focused on a PMO population, if they were stratified by sex and age to identify the PMO population, if they reported fracture endpoints, or if they covered U.S. pharmacoeconomic data.

Results: Current pharmacotherapy for PMO includes anti-resorptive agents (bisphosphonates, selective estrogen receptor modulators, and calcitonin), which reduce bone turnover, and anabolic agents (parathyroid hormone), which stimulate bone development. Antiresorptive products reduce vertebral fracture rates by 30% to 70% and are cost-effective in preventing fractures in women with osteoporosis and low bone mineral density (BMD) or with a previous fragility fracture. Teriparatide, a parathyroid hormone (PTH) reduces vertebral fracture rates by 65% to 69%, although cost-effectiveness is limited to high-risk patients of advanced age or with very low BMD. Promising products under review include strontium ranelate, available for PMO outside the U.S., and PTH (1-84), an anabolic agent. canadian discount drugs

Conclusion: Antiresorptive agents are cost-effective for preventing fractures in women with osteoporosis, but they might not offer enough protection in high-risk populations. Thus, there is a cost-effective place for an anabolic agent in the highest-risk patients. Strontium ranelate and PTH (1-84) may offer additional therapeutic options in preventing fractures in PMO.