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01-12-2020 | Osteoporosis | Original Article

Comparison of treatment strategies and thresholds for optimizing fracture prevention in Canada: a simulation analysis

Authors: William D. Leslie, Suzanne N. Morin, Lisa M. Lix, Neil Binkley

Published in: Archives of Osteoporosis | Issue 1/2020

Abstract

Summary

This comparison of osteoporosis treatment strategies and intervention thresholds highlights tradeoffs in terms of number of individuals qualifying for treatment and estimated fractures prevented.

Purpose

The current analysis was performed to inform the following key question as part of the Osteoporosis Canada’s Osteoporosis Guidelines Update: “What is the best strategy to identify those at high fracture risk for pharmacotherapy in order to prevent the most fractures, considering both population and patient perspectives?”

Methods

The study population consisted of 66,878 women age 50 years and older (mean age 66.0 ± 9.7 years) with documented fracture probability assessment (FRAX) and fracture outcomes. Fractures over the next 5 years were identified through linked administrative healthcare data. We estimated the fraction of the population that would warrant treatment and the number of fractures avoided per 1000 person-years according to multiple strategies and thresholds. Strategies were then rank ordered using 19 metrics.

Results

During mean 4.4 years, 863 (3.5%) sustained one or more major osteoporotic fractures (MOF), 212 (0.8%) sustained a hip fracture, and 1210 (4.9%) sustained any incident fracture. For woman age 50–64 years, the highest ranked strategy was treatment based upon total hip T score ≤ −2.5, but several other strategies fell within 0.5 overall ranking. For women age 65 years and older, MOF > 20% was the highest ranked strategy with no closely ranked strategies. Pooling both age subgroups gave MOF > 20% as the highest ranked strategy, with several other strategies within 0.5 overall ranking.

Conclusions

Choice of treatment strategy and threshold for osteoporosis management strongly influences the number of individuals for whom pharmacologic treatment would be recommended and on estimated fracture rates in the population. This evidence-based approach to comparing these strategies will help to inform guidelines development in Canada and may be on interest elsewhere.

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Title: Comparison of treatment strategies and thresholds for optimizing fracture prevention in Canada: a simulation analysis
Authors: William D. Leslie
Suzanne N. Morin
Lisa M. Lix
Neil Binkley
Publication date: 01-12-2020
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Archives of Osteoporosis / Issue 1/2020
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-019-0660-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of treatment strategies and thresholds for optimizing fracture prevention in Canada: a simulation analysis

Abstract

Summary

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusions

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