Buckley Lenore M, Hillner Bruce E
Virginia Commonwealth University, Richmond 23298, USA.
J Rheumatol. 2003 Jan;30(1):132-8.
To assess the relative costs and benefits of calcium and vitamin D supplements, cyclic etidronate, or alendronate in the prevention of vertebral fractures for women and with normal bone density and osteopenia who are about to initiate moderate dose glucocorticoid treatment.
Using a decision analysis model, we evaluated the following patients: 4 hypothetical cohorts: 30-yr-old women with normal lumbar spine (LS) bone mineral density (BMD) (t score = 0), 50-yr-old women with borderline osteopenia (t score = -1), 60-yr-old women with moderate osteopenia (t score = -1.5), and 70-yr-old women with severe osteopenia (t score = -2) treated with a mean prednisone dose of 10 mg/day for one year. The main outcomes included the development of vertebral fractures 10 years after glucocorticoid treatment and at age 80 (life-time risk) and direct and indirect costs.
At 10 years, calcium and vitamin D supplements decreased fracture rates by 30-50% at a minimal cost (US$800 or less per vertebral fracture avoided) or at a cost saving compared to no treatment for women with osteopenia (t score -1 to -2). Etidronate and alendronate are most cost effective in women with borderline osteoporosis (t scores of -1.5 and -2) in the 10 year analysis. In the life-time analysis, calcium and vitamin D treatment yielded a cost savings compared to no treatment for all groups with osteopenia. Etidronate decreased fracture rates further in all groups at a cost of less than $2,000 per fracture prevented. Alendronate reduced the fracture risk further at cost of $3,000-7,000 per fracture avoided.
Calcium and vitamin D supplements and low cost bisphosphonate regimens such as cyclic etidronate decrease the life-time vertebral fracture risk at acceptable costs and should be considered when initiating glucocorticoid treatment for women who do not have osteoporosis.
评估钙和维生素D补充剂、环膦酸或阿仑膦酸钠对于即将开始中等剂量糖皮质激素治疗且骨密度正常或骨质减少的女性预防椎体骨折的相对成本和效益。
我们使用决策分析模型评估了以下患者：4个假设队列：腰椎（LS）骨矿物质密度（BMD）正常（t值=0）的30岁女性、骨质减少临界值（t值=-1）的50岁女性、中度骨质减少（t值=-1.5）的60岁女性以及严重骨质减少（t值=-2）的70岁女性，她们均接受平均剂量为10毫克/天的泼尼松治疗1年。主要结局包括糖皮质激素治疗10年后及80岁时（终身风险）椎体骨折的发生情况以及直接和间接成本。
10年后，对于骨质减少（t值-1至-2）的女性，钙和维生素D补充剂以最低成本（每避免一例椎体骨折800美元或更低）或与不治疗相比节省成本的情况下，使骨折率降低了30%-50%。在10年分析中，依替膦酸和阿仑膦酸钠在骨质减少临界值（t值为-1.5和-2）的女性中最具成本效益。在终身分析中，与不治疗相比，钙和维生素D治疗在所有骨质减少组中均节省了成本。依替膦酸使所有组的骨折率进一步降低，每预防一例骨折的成本低于2000美元。阿仑膦酸钠进一步降低了骨折风险，每避免一例骨折的成本为3000-7000美元。
钙和维生素D补充剂以及低成本双膦酸盐方案（如环膦酸）以可接受的成本降低了终身椎体骨折风险，对于未患骨质疏松症的女性开始糖皮质激素治疗时应予以考虑。
