The economics of osteoporosis and its prevention. A review.

A systematic review of all published economic evaluations of treatments for the prevention of osteoporosis since 1980 was undertaken. 21 published studies were identified. The majority of the studies were set in the context of the US healthcare system. Non-US studies were heavily influenced by the methodologies of 1 US research group. All studies published before 1990 only considered the use of hormone replacement therapy (HRT) at the menopause for osteoporosis prevention. Since 1990 a number of studies have looked at other therapies as well as HRT in older women. All studies that have made a direct comparison between using HRT at the menopause with HRT in older women have suggested that it is more cost effective to initiate therapy in older non-perimenopausal women. However, there is a paucity of evidence from randomised controlled trials on which to base assumptions on costs and effectiveness. Large randomised trails with hip fracture as the main outcome measure are required to answer key economic and clinical questions.