Cost-effectiveness of antiosteoporosis strategies for postmenopausal women with osteoporosis in China.
Menopause. 2019 Apr 15. doi: 10.1097/GME.0000000000001339
Li N1,2, Zheng B1,2, Liu M1,2, Zhou H1, Zhao L2, Cai H1,2, Huang J3.
Cost of 40 years of treatment (for similar benefits)
| Calcium/vitamin D | $3,800 |
| Zoledronate | $8,400 |
| Alendronate | $9,800 |
| Teriparatide | $34,800 |
| Raloxifene | $13,400 |
- Vitamin D helps treat Osteoporosis – Sept 2018
- Osteoporosis 4X more likely if poor gut (probably poor vitamin D absorption) – Aug 2017
- There are many low-cost gut-friendly forms of vitamin D
- 800 IU Vitamin D proven again to not be enough to stop bone loss - Aug 2015
- Vitamin D receptors get worse with age with osteoporosis – Dec 2018
- Poor genes limit amount of vitamin D getting to the bones
- Gut-Friendly Vitamin D
- People have become aware that Vitamin D helps bones, while osteo doctors have been losing business
Items in both categories Calcium and Osteopososis are listed here:
- Osteoporosis treatment – Vitamin D is the most cost-effective – April 2019
- Calcium added for osteoporosis may not help and might be harmful – Feb 2018
- Calcium Essential to Limit Osteoporosis but Avoid Excess, Say Europeans - Nov 2017
- Calcium from plants might be OK – Dec 2016
- Calcium supplements proven to NOT reduce fractures, but are proven to INCREASE heart problems – July 2015
- Osteoporosis spot therapies: vitamin D with Calcium was the most popular – Feb 2013
- Calcium and bone disorders in pregnancy – May 2012
- Calcium citrate and more than 800 IU of vitamin D to treat Osteoporosis – Mar 2011
- Overview Fractures and vitamin D
- Overview Osteoporosis and vitamin D
- Just 700 IU of vitamin D and 700 mg of Calcium reduces falls and fractures – Nov 2010
- 4X more likely to add Calcium to diet than take supplements – Sept 2010
- 890 IU of vitamin D and 1200 mg Calcium improved bone density – July 2010
Overview Osteoporosis and vitamin D contains the following summary
- FACT: Bones need Calcium (this has been known for a very long time)
- FACT: Vitamin D improves Calcium bioavailability (3X ?)
- FACT: Should not take > 750 mg of Calcium if taking lots of vitamin D (Calcium becomes too bio-available)
- FACT: Adding vitamin D via Sun, UV, or supplements increased vitamin D in the blood
- FACT: Vitamin D supplements are very low cost
- FACT: Many trials, studies. reviews, and meta-analysis agree: adding vitamin D reduces osteoporosis
- FACT: Toxic level of vitamin D is about 4X higher than the amount needed to reduce osteoporosis
- FACT: Co-factors help build bones.
- FACT: Vitamin D Receptor can restrict Vitamin D from getting to many tissues, such as bones
- It appears that to TREAT Osteoporosis:
- Calcium OR vitamin D is ok
- Calcium + vitamin D is good
- Calcium + vitamin D + other co-factors is great
- Low-cost Vitamin D Receptor activators sometimes may be helpful
- CONCLUSION: To PREVENT many diseases, including Osteoporosis, as well as TREAT Osteoporosis
- Category Osteoporosis has
189 items - Category Bone Health has
269 items Note: Osteoporosis causes bones to become fragile and prone to fracture
Osteoarthritis is a disease where damage occurs to the joints at the end of the bonesFalls and Fractures category contains the following summary
219 items in FALLS and FRACTURES - see also Overview Seniors and Vitamin D
- Overview Fractures and Falls and Vitamin D
- Deaths due to falls doubled in just a decade (age-adjusted, perhaps decreased vitamin D) – June 2019
- Preventing Falls in Older Adults – Vitamin D combination is the best - JAMA Meta-analysis Nov 2017
- Falls cut in half by 100,000 IU vitamin D monthly - RCT 2016
- Vitamin D prevents falls – majority of meta-analyses conclude – meta-meta analysis Feb 2015
- Vitamin D and fractures – 24 meta-analyses and counting – Dec 2014
Hip fracture
- Search Vitamin D Life for "HIP FRACTURE" 191 items not in PDF as of July 2020
- A call to action: Vitamin D for hip fracture – Holick July 2020
- Risk factors for death after hip fracture surgery – 7 of the 8 are associated with low vitamin D – Aug 2020
- 3.5 X higher risk of death 2 years after hip fracture surgery if low vitamin D – Jan 2020
- Hip fracture recovery best with home exercise plus Vitamin D – RCT Dec 2018
- Hip fracture 58 percent more likely if low vitamin D – meta-analysis March 2017
- Fracture risk 40 percent higher risk if low Vitamin D - June 2019
- 1 in 3 died after hip fracture but only 1 in 14 if add Vitamin D and exercise – RCT April 2017
OBJECTIVE:
Osteoporosis has become an important public health problem in China, especially among elderly postmenopausal women. Massive amounts of medical and health resources have been devoted to patients with osteoporosis and osteoporosis-related fractures. This study estimated the cost-effectiveness of alendronate, zoledronate, raloxifene, teriparatide, and calcium/vitamin D as treatments for osteoporosis in elderly postmenopausal women in China from the medical system perspective.METHODS:
A Markov model was constructed by using TreeAge Pro 2015 software. This model simulated the disease process over 40 years in response to the five investigated therapeutic strategies. Each cycle lasted for 1 year. The model parameters included Chinese epidemiological data, clinical effectiveness, cost, and utility. Total treatment costs and quality-adjusted life-years (QALYs) were estimated, and incremental cost-effectiveness analysis was performed. Univariate and probabilistic sensitivity analyses were conducted to verify the model.RESULTS:
The calcium/vitamin D strategy, zoledronate, alendronate, teriparatide, and raloxifene offered patients 10.24, 10.83, 10.70, 10.88, and 10.54 QALYs at the cost of $3,799.72, $8,425.61, $9,849.89, $34,843.72, and $13,353.33 for over 40 years, respectively. The alendronate and raloxifene strategies were eliminated because they were less effective and more expensive than the other strategies. The base-case analysis revealed that the incremental cost-effectiveness ratios (ICERs) of the zoledronate strategy relative to those of the calcium/vitamin D strategy were $7,864.59/QALY. This result indicated that the zoledronate strategy was more cost-effective than other strategies and was within the willingness-to-pay threshold of China ($28,624/QALY). The ICERs of the teriparatide versus zoledronate strategies were $4,70,797.08/QALY, which exceeded the threshold.CONCLUSION:
From the perspective of the Chinese medical system, zoledronate is more cost-effective than the calcium/vitamin D strategy, alendronate, raloxifene, and teriparatide for the treatment of osteoporosis in elderly postmenopausal women. Not factoring the parameters of adherence and persistence in, and consequent variability in treatment effectiveness relative risks, seems like a major limitation, but it can be speculated that it would not change the conclusion that zoledronate is the most economical strategy.Osteoporosis treatment – Vitamin D is the most cost-effective – April 2019Printer Friendly PDF this page! Follow this page for updates815 visitors, last modified 21 Apr, 2019,
- Category Bone Health has