Risque à long terme de survenue d'une fracture ostéoporotique en Belgique.

in Revue Médicale de Liège (2008), 63(7-8), 480-487

This work has been realised to estimate the lifetime risk of osteoporotic fracture for Belgian men and women aged 50 and 60 years. Estimates were based on a microsimulation Markov model. They take account ... [more ▼]

This work has been realised to estimate the lifetime risk of osteoporotic fracture for Belgian men and women aged 50 and 60 years. Estimates were based on a microsimulation Markov model. They take account of the incidence of fracture as well as of life expectancy. Several approaches have been taken to model life expectancy. Our estimates also take account of future mortality reductions based on official estimates and secular trends in life expectancy. Lifetime risk of osteoporotic population (bone mineral density below -2.5 T-score) was also estimated. Lifetime risk of hip fracture and any major osteoporotic fracture (hip, clinical vertebral or wrist) were 20.5% and 39% respectively for women aged 60 years. Corresponding values for men were 7.9% and 14.8% and for osteoporotic women 32.3% and 53.4%. Our lifetime risk estimates re-emphasize that osteoporosis is a major public health problem and that its societal burden is likely to increase due to demographic changes. [less ▲]

Strontium ranelate: The first agent of a new therapeutic class in osteoporosis.

in Advances in Therapy (2008), 25(12), 1235-56

Strontium ranelate is a new agent developed for the management of post-menopausal osteoporosis. It has a unique mode of action, based on an uncoupling between bone formation (increased) and bone ... [more ▼]

Strontium ranelate is a new agent developed for the management of post-menopausal osteoporosis. It has a unique mode of action, based on an uncoupling between bone formation (increased) and bone resorption (decreased). To review its effectiveness we searched the MEDLINE database from 1985 to 2008, as well as databases such as the Cochrane controlled register, for citations or relevant articles. After this extensive search of the literature, a critical appraisal of the data was obtained through a consensus meeting (AN, MH, SS, OB, and J-YR). We found that strontium ranelate reduces vertebral, nonvertebral, major nonvertebral, and hip fractures over 1, 3, 4, and 5 years. Its spectrum of activity covers women with osteopenia, osteoporosis, and severe osteoporosis. Elderly subjects also show a reduction in vertebral and nonvertebral fractures. Bone mineral density may be used as a monitoring tool for strontium ranelate, since early changes are predictive of long-term fracture reduction. Biochemical markers of bone turnover reflect the uncoupling between resorption and formation. The safety profile of strontium ranelate compares favorably with the other currently marketed antiosteoporosis medications. Preliminary results suggest that strontium ranelate is able to reduce the progression of spine osteoarthritis. In conclusion, strontium ranelate has the potential to be a candidate for first-line treatment of osteopenia and osteoporosis. However, further research is needed before suggesting its widespread use in osteoarthritis. [less ▲]

An Economic Evaluation of Quantitative Ultrasonometry as Pre-Screening Test for the Identification of Patients with Osteoporosis

in Disease Management & Health Outcomes (2008), 16(6), 429-438

Background: Screening for osteoporosis has been recommended to identify patients at high risk of fracture in order to provide preventative treatment. Given the limited availability of dual-energy x-ray ... [more ▼]

Background: Screening for osteoporosis has been recommended to identify patients at high risk of fracture in order to provide preventative treatment. Given the limited availability of dual-energy x-ray absorptiometry (DXA) and health resources, quantitative ultrasonometry (QUS) has emerged as an attractive tool for the mass screening scenario. The objective of this study was to evaluate whether a screening strategy using QUS as a pre-screening tool for bone densitometry would be cost effective and, if so, at what cut-off thresholds. Methods: Decision analytic models were used to compare the cost effectiveness and cost utility of several screening strategies: DXA measurement alone and pre-screening strategies that use different QUS index cut-off thresholds. For each strategy, and for hypothetical cohorts of women, we estimated the number of DXA scans required, the number of osteoporotic patients detected and missed, the total screening cost, and the incremental cost per patient detected. A validated Markov microsimulation model with a lifetime horizon and from a healthcare perspective was also computed in order to estimate the cost per quality-adjusted life-year (QALY) gained of the alternative screening strategies combined with 5 years of alendronate therapy for women who have osteoporosis (T-score -2.5 or less). Results: The DXA strategy had the highest cost and the highest number of patients with osteoporosis detected. Pre-screening strategies using QUS reduced the number of DXA scans per patient with osteoporosis detected and the total screening cost but they also missed patients with osteoporosis as the QUS index decreased. Pre-screening strategies using QUS T-scores of 0.0, -0.5, -2.0, and -2.5 were dominated by extended dominance, as their incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were higher than that of the next more effective alternative. The cost-effectiveness and cost-utility frontiers included no screening, pre-screening using QUS T-scores of -1.0 and -1.5, and DXA measurement alone. Conclusion: These results suggest that QUS may be useful as a pre-screening tool for bone densitometry given the limited availability of DXA and health resources, and that the QUS index T-scores of -1.0 and -1.5 are the most appropriate index. [less ▲]

Efficience d'un dépistage de masse de l'ostéoporose par ultrasons: approche économique par microsimulation

in Revue du Rhumatisme (2007, December), 74(10-11), 1072-3

Cost-effectiveness of osteoporosis screening campaign for Belgian women

in Value in Health (2007, October), 10(6), 395

Prevention of hip fractures in osteoporosis

in Minerva Ortopedica e Traumatologica (2007), 58(5), 423-437

Hip fracture is the major clinical consequence of osteoporosis. It is linked with decreased life expectancy and quality of life, placing an ever increasing burden on health services. Few medications have ... [more ▼]

Hip fracture is the major clinical consequence of osteoporosis. It is linked with decreased life expectancy and quality of life, placing an ever increasing burden on health services. Few medications have unequivocally demonstrated their ability to reduce hip fracture risk in osteoporotic subjects. Daily alendronate and risedronate reduce hip fracture in patients with low bone mineral density and prevalent vertebral fractures. Intravenous bisphosphonates have been developed, in response to long-term poor adherence to oral anti-osteoporotic treatments. Once-yearly zoledronic acid reduces fracture rates at the spine, non-spine and hip locations. Strontium ranelate, the first drug to uncouple bone formation from bone resorption has also demonstrated its ability to reduce hip fractures in patients above 74 years old, with prevalent low bone mineral density. Calcium and vitamin D supplementation are prerequisite for the management of elderly subjects and should always been associated to anti-resorptive or bone forming agents. Non-pharmacological management of osteoporosis is recommended cannot be considered a substitute for pharmacological treatment of osteoporosis, not even in old age. [less ▲]