Recommendations for The Conduct of Economic Evaluations in Osteoporosis: Outcomes of An Experts’ Consensus Meeting Organized by The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) And the US Branch of The International Osteoporosis Foundation

Summary Economic evaluations are increasingly used to assess the value of health interventions, but variable quality and heterogeneity limit the use of these evaluations by decision-makers. These recommendations provide guidance for the design, conduct, and reporting of economic evaluations in osteoporosis to improve their transparency, comparability, and methodologic standards. Introduction This paper aims to provide recommendations for the conduct of economic evaluations in osteoporosis in order to improve their transparency, comparability, and methodologic standards. Methods A working group was convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis to make recommendations for the design, conduct, and reporting of economic evaluations in osteoporosis, to define an osteoporosis-specific reference case to serve a minimum standard for all economic analyses in osteoporosis, to discuss methodologic challenges and initiate a call for research. A literature review, a face-to-face meeting in New York City (including 11 experts), and a review/approval by a larger group of experts worldwide (including 23 experts in total) were conducted. Results Recommendations on the type of economic evaluation, methods for economic evaluation, modeling aspects, base-case analysis and population, excess mortality, fracture costs and disutility, treatment characteristics, and model validation were provided. Recommendations for reporting economic evaluations in osteoporosis were also made and an osteoporosis-specific checklist was designed that includes items to report when performing an economic evaluation in osteoporosis. Further, 12 minimum criteria for economic evaluations in osteoporosis were identified and 12 methodologic challenges and need for further research were discussed. Conclusion While the working group acknowledges challenges and the need for further research, these recommendations are intended to supplement general and national guidelines for economic evaluations, improve transparency, quality, and comparability of economic evaluations in osteoporosis, and maintain methodologic standards to increase their use by decision-makers

HUBUNGAN PENGETAHUAN, PERSEPSI ANCAMAN OSTEOPOROSIS DAN TINGKAT EKONOMI DENGAN PENGGUNAAN SUSU TINGGI KALSIUM Studi Kasus di RW I dan III Kelurahan Gisikdrono Kecamatan Semarang Bara

Latar belakang : Satu dari tiga wanita mempunyai kecenderungan terkena osteoporosis. Susu merupakan salah satu sumber kalsium yang memberikan dampak positif bagi kesehatan terutama untuk mencegah osteoporosis. Konsumsi susu rata-rata penduduk Indonesia mengalami penurunan dibandingkan angka konsumsi sebelum krisis ekonomi. Faktor penting lain yang mempengaruhi konsumsi susu yaitu pengetahuan dan persepsi ancaman, yang meliputi persepsi kerentanan, keseriusan, manfaat dan hambatan. Tujuan penelitian adalah untuk mengetahui hubungan antara pengetahuan, persepsi ancaman osteoporosis dan tingkat ekonomi dengan penggunaan susu tinggi kalsium. Metoda : Penelitian ini merupakan penelitian korelasional yang semua variabelnya dikumpulkan dalam waktu yang sama. Sampel sejumlah 64 orang anggota PKK di RW I dan III Kelurahan Gisikdrono Kecamatan Semarang Barat diambil dengan menggunakan metode multistage sampling. Data diperoleh melalui metode wawancara. Analisis data dilakukan dengan menggunakan program Statistical Package for the Social Science (SPSS). Untuk menguji hipotesis digunakan Kendall’s tau test dengan derajat kepercayaan 95 %. Hasil : Ada hubungan antara pengetahuan tentang osteoporosis dengan penggunaan susu tinggi kalsium (r = 0,395 ; p = 0,000), persepsi ancaman osteoporosis dengan penggunaan susu tinggi kalsium (r = 0,205 ; p = 0,031) dan tingkat ekonomi dengan penggunaan susu tinggi kalsium (r = 0,449 ; p = 0,000) Kesimpulan : Pengetahuan, persepsi ancaman osteoporosis dan tingkat ekonomi memiliki hubungan yang bermakna dengan penggunaan susu tinggi kalsium. Disarankan untuk dilakukan penelitian lanjutan dan penyuluhan untuk meningkatkan pengetahuan masyarakat tentang osteoporosis terutama mengenai sebab, akibat dan cara pencegahannya

Radiographic Evaluation of Osteoporosis Through Detection of Jaw Bone Changes: a Simplified Early Osteoporosis Detection Effort

Osteoporosis has become a worldwide problem and has been known as a silence disease. Nowadays, there are a lot of diagnostic tools for detecting osteoporosis. Eighty eight postmenopausal were included and underwent digital panoramic, digital periapical, and conventional radiography. Ultrasound bone densitometry of os calcis used as gold standard. Correlation between stiffness index (SI) with a digital dental, digital panoramic and conventional dental radiography are 0.170 (p = 0.11), -0382 (p = 0.001) and 0.246 (p = 0.021) respectively. Significant relationship was found between the SI only with digital panoramic and conventional dental. The highest correlation was found between SI values with mandibular Inferior Cortex on digital panoramic (-0.382, Pearson Correlation Tests). Correlation between digital panoramic radiographs and the SI values was the highest of the three radiographic modalities in this study. This indicates that evaluation of cortical bone is more accurate than cancellous bone. Bone quality evaluation in patients at high risk for osteoporosis using panoramic and dental conventional radiograph by dentist, contributes in preventing further occurrence of osteoporosis which in turn could reduce mortality and morbidity of osteoporosis in Indonesia

Comparison of osteoporosis pharmacotherapy fracture rates: Analysis of a marketScan® claims database cohort

Background: Several different classes of medications have been shown to be efficacious at preventing fractures in patients with osteoporosis. No study has compared real world efficacy at preventing fractures between all currently approved medications. Objectives: To directly compare the efficacy of all currently available osteoporosis medications by using a large population claims database. Methods: The Truven Health Analytics MarketScan® database from 2008 - 2012 was used to identify all patients who started a new osteoporosis medication. Patients who experienced a fracture after at least 12 months of treatment were identified and risk factors for fracture for all patients were recorded. Logistic regression was used to account for and quantify the contribution of risk factors, and to make direct comparisons between different osteoporosis medications. Results: A total of 51649 patients were included in the cohort, with an average age of 56 years. The overall incidence rate of fracture was 1.55 per 100 person - years of treatment. Orally administered medications had the lowest fracture rates, led by raloxifene and alendronate (1.24 and 1.54 respectively), while parenterally administered medications including teriparatide and zolerdonic acid had the highest rates (3.90 and 1.98 respectively). No statistically significant differences found between oral or parenterally administered bisphosphonate medications. Conclusions: While patients taking orally administered drugs including bisphosphonates had less frequent incident fracture no statistically significant differences were found between most drugs in head - to - head comparisons, even considering the route of administration of bisphosphonates. These findings support previous evidence that minimal differences in efficacy exist between different osteoporosis medications. This is the first study using a large database to compare all currently available osteoporosis treatments and will hopefully be augmented by further study to provide more evidence to make clinical decisions on osteoporosis medication use. © 2017 American Association of Neuropathologists, Inc

A suggested prototype for assessing bone health

Background- Osteoporosis is becoming a health concern worldwide. Considering the fact that prevention plays an important role in reducing the burden of this silent disease and in view of the limited resources available, many countries have adopted certain programs to fight osteoporosis through shifting their attention towards at-risk individuals. The Iranian Multicenter Osteoporosis Study (IMOS) is one of these programs. The program aims to assess bone health and the prevalence of vitamin D deficiency in different parts of Iran with various altitudes, latitudes and lifestyle habits in a way that the results could be generalized to the country. Method- The present article presents the protocol used in the third phase of the study. It was designed based on the experiences gathered in the previous phases to overcome the shortcomings particularly subject loss. The questionnaire applied in this study was developed based on a thorough literature review of the risk factors and secondary causes of osteoporosis and was approved by an expert panel. It should be added that while the majority of the existing studies aim to study a certain aspect of osteoporosis, the present protocol provides the information needed for policy makers and researchers to study different osteoporosis-related issues. Conclusion- The authors believe the protocol, to be implemented with small modifications, can help policymakers in different parts of the world, particularly developing countries, gather accurate information on different aspects of bone health at the national level. © 2015, Academy of Medical Sciences of I.R. Iran. All rights reserved

The relationship between anthropometric parameters and bone mineral density in an Iranian referral population

Osteoporosis is a common health concern in both developed and developing countries. In this study the association between anthropometric measures and osteoporosis was investigated in 3630 males and females visiting BMD clinic of Shariati Hospital, Tehran, Iran, a teaching hospital and referral center for osteoporosis affiliated to the Tehran University of Medical Sciences. Anthropometric measurements obtained and also Bone Mineral Density (BMD) measurement was done using a Lunar DPXMD densitometer. Data were analyzed using SPSS with Chi-square and ANOVA with post-hoc tests. Results showed that the weight, BMI and age had the strongest correlation with the BMD values in the studied people. While age is negatively correlated with BMD in all the studied people, a positive association was noted between weight, height and BMI and BMD parameters (P<0.01). It was concluded that certain anthropometric parameters (BMI and weight) can considerably affect one's risk of developing osteoporosis. Further research on the effect of these variables on the association of weight and BMD is needed

Genetic studies of osteoporosis in Malta : a review

Osteoporosis is a complex metabolic disease with a strong genetic component which results in a decrease in bone mineral density and deterioration in the microarchitecture of bone, leading to an increased risk of fractures. During the last decade, a number of genetic studies of the Maltese population were performed to determine a potential genetic component which increases the individual’s susceptibility to osteoporosis. Both family and population case-control approaches were used. Linkage analysis using large affected families has identified a region on chromosome 11p12, following which functional studies have shown that variations within two genes found in that region namely, TRAF6 and CD44, affect gene expression, and, more specifically, pre-mRNA splicing in the case of CD44. This is the first report of strong suggestive linkage of 11p12 to osteoporosis. Using the candidate gene approach, selected candidate genes, which had been studied in other populations and been found to increase susceptibility to osteoporosis to varying degrees in some of them, included those coding for the vitamin D and oestrogen receptors (VDR & ER1), osteoprotegerin (TNFRSF11B), collagen type 1 (COL1A1), methylenetetrahydrofolate reductase (MTHFR) and lipoprotein receptor related protein (LRP)-5. In the Maltese population, the most significant result showed that a polymorphism in the promoter region of TNFRSF11B, which codes for osteoprotegerin, had a significant effect on bone mineral density, thus increasing the susceptibility to osteoporosis. These studies have shown that variations within three different genes, namely TRAF6, CD44 and TNFRSF11B, all involved in osteoclast biology, might increase the risk of osteoporosis and could therefore serve as targets for novel therapeutic agents.peer-reviewe

Use of quantitative ultrasound scans of the calcaneus to diagnose osteoporosis in patients with rheumatoid arthritis

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis.Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist andCUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosedby the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis.Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of theCUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis.Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have arole in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. <br/

Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment

Introduction: Since alendronate became available in generic form in the Unites States in 2008, its price has been decreasing. The objective of this study was to investigate the impact of alendronate cost on the cost-effectiveness of osteoporosis screening and treatment in postmenopausal women. Methods: Microsimulation cost-effectiveness model of osteoporosis screening and treatment for U.S. women age 65 and older. We assumed screening initiation at age 65 with central dual-energy x-ray absorptiometry (DXA), and alendronate treatment for individuals with osteoporosis; with a comparator of "no screening" and treatment only after fracture occurrence. We evaluated annual alendronate costs of $20 through$800; outcome measures included fractures; nursing home admission; medication adverse events; death; costs; quality-adjusted life-years (QALYs); and incremental cost-effectiveness ratios (ICERs) in 2010 U.S. dollars per QALY gained. A lifetime time horizon was used, and direct costs were included. Base-case and sensitivity analyses were performed. Results: Base-case analysis results showed that at annual alendronate costs of $200 or less, osteoporosis screening followed by treatment was cost-saving, resulting in lower total costs than no screening as well as more QALYs (10.6 additional quality-adjusted life-days). When assuming alendronate costs of$400 through $800, screening and treatment resulted in greater lifetime costs than no screening but was highly cost-effective, with ICERs ranging from$714 per QALY gained through $13,902 per QALY gained. Probabilistic sensitivity analyses revealed that the cost-effectiveness of osteoporosis screening followed by alendronate treatment was robust to joint input parameter estimate variation at a willingness-to-pay threshold of$50,000/QALY at all alendronate costs evaluated. Conclusions: Osteoporosis screening followed by alendronate treatment is effective and highly cost-effective for postmenopausal women across a range of alendronate costs, and may be cost-saving at annual alendronate costs of $200 or less. © 2012 Nayak et al