Osteoporosis and fracture prevention: costs and effects modeled on the Rotterdam study

Osteoporosis is defined, by consensus, as a systemic skeletal disease. characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture,' It is well known that there is an important age-related decrease in bone mass and bone strength as witnessed by the exponential increase of hip fractures with age.2 Osteoporosis is primarily described in postmenopausal women but men arc not free from it. and a quarter of the hip fractures occurs in men.3 Osteoporosis and its direct consequences, fractures, are major concerns for public health since they arc associated with increased death rates and with substantial disability. :Moreover, they represent an important cost for the public health budget. 'TIle European Commission estimated in a recent report the cost of osteoporosis in the countries of the European Union at € 3.5 billion annually for hospital health care alone,4 and an American study estimated the total health care expenditure attributable to osteoporotic fractures in the United States at USS 13.8 billion (€ 12.4 billion) in 1995.' Without intervention, the improved life expectancy and the demographic evolution will cause the number of hip fractures worldwide to increase from around 1.7 million in 1990 to over 6 million in 2050.6 Therefore, it can be expected that medical expenditure will also increase in the coming decades. Osteoporosis, defined as a reduction in bone mass below a specified threshold, has been shown to be a major determinant of fracture risk.7 Bone mass can be measured with sufficient accuracy and precision and it is currently the best available indicator of fracture risk, other than age and gender. There is, however, a considerable overlap of bone density values between people who develop fractures and people who do not.2 The central goal of this thesis is to study the cost of osteoporosis and fractures in the Netherlands and to develop mathematical models for estimating fracture risk based on Dutch epidemiological data. These models are then used in simulations to analyze the effects of potential preventive measures against osteoporotic fractures. 'The most disabling of these is the hip fracture, but also wrist fractures and fractures of the vertebrae are considered as osteoporotic fractures.8 Also from a cost perspective the importance of hip fractures appears to be overwhelming, and therefore the models focus is on hip fractures.

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