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Open Access 01-12-2015 | Research

Public health impact and cost-effectiveness of dairy products supplemented with vitamin D in prevention of osteoporotic fractures

Authors: Olivier Ethgen, Mickaël Hiligsmann, Nansa Burlet, Jean-Yves Reginster

Published in: Archives of Public Health | Issue 1/2015

Abstract

Background

Dietary sources of calcium and vitamin D are recommended as a first-line strategy in prevention of osteoporosis-related fractures but their public health and economic impact has never been studied.

Methods

We designed a population-based model to forecast the potential health outcomes and medical effectiveness of the daily administration of dairy supplements containing 800 IU of vitamin D and 1 g of calcium in cohorts of subjects, from both genders, aged 50, 60, 70 and 80 years. Annual costs of dairy products were tested at €150, €250 and €350.

Results

In total, the daily intake of vitamin-D rich dairy products reduces by 30,376 and 16,105 events the number of osteoporotic fractures in women and men respectively and permits to gain 6605 and 6144 life-years, in women and men respectively. This intervention is cost-effective from 70 years on in the general population and from 60 years on in patients at increased risk of osteoporotic fractures.

Conclusion

The recommendation to use dairy products as the preferred source of calcium and vitamin D in aging males and females is supported by public health and health economic analyses.

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Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D. Guidelines for diagnosis and management of osteoporosis. The European Foundation for Osteoporosis and Bone Disease. Osteoporos Int. 1997;7(4):390–406.CrossRefPubMed

Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY, et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57. doi:10.1007/s00198-012-2074-y.PubMedCentralCrossRefPubMed

Svedbom A, Hernlund E, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. 2013;8:137. doi:10.1007/s11657-013-0137-0.PubMedCentralCrossRefPubMed

Strom O, Borgstrom F, Kanis JA, Compston J, Cooper C, McCloskey EV, et al. Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2011;6:59–155. doi:10.1007/s11657-011-0060-1.CrossRefPubMed

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013;8:136. doi:10.1007/s11657-013-0136-1.PubMedCentralCrossRefPubMed

Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton 3rd LJ. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993;137(9):1001–5.PubMed

Rizzoli R, Boonen S, Brandi ML, Bruyere O, Cooper C, Kanis JA, et al. Vitamin D supplementation in elderly or postmenopausal women: a 2013 update of the 2008 recommendations from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Curr Med Res Opin. 2013;29(4):305–13. doi:10.1185/03007995.2013.766162.CrossRefPubMed

Bruyere O, Slomian J, Beaudart C, Buckinx F, Cavalier E, Gillain S, et al. Prevalence of vitamin D inadequacy in European women aged over 80 years. Arch Gerontol Geriatr. 2014;59(1):78–82. doi:10.1016/j.archger.2014.03.010.CrossRefPubMed

Bruyere O, Malaise O, Neuprez A, Collette J, Reginster JY. Prevalence of vitamin D inadequacy in European postmenopausal women. Curr Med Res Opin. 2007;23(8):1939–44. doi:10.1185/030079907X219562.CrossRefPubMed

10.

Bruyere O, De Cock C, Mottet C, Neuprez A, Malaise O, Reginster JY. Low dietary calcium in European postmenopausal osteoporotic women. Public Health Nutr. 2009;12(1):111–4. doi:10.1017/S1368980008002024.CrossRefPubMed

11.

Bruyere O, Cavalier E, Souberbielle JC, Bischoff-Ferrari HA, Beaudart C, Buckinx F, et al. Effects of vitamin D in the elderly population: current status and perspectives. Arch Public Health. 2014;72(1):32. doi:10.1186/2049-3258-72-32.PubMedCentralCrossRefPubMed

12.

Rizzoli R, Stevenson JC, Bauer JM, van Loon LJ, Walrand S, Kanis JA, et al. The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Maturitas. 2014;79(1):122–32. doi:10.1016/j.maturitas.2014.07.005.CrossRefPubMed

13.

Hiligsmann M, Ben Sedrine W, Bruyere O, Evers SM, Rabenda V, Reginster JY. Cost-effectiveness of vitamin D and calcium supplementation in the treatment of elderly women and men with osteoporosis. Eur J Pub Health. 2015;25(1):20–5. doi:10.1093/eurpub/cku119.CrossRef

14.

Reginster JY. Calcium and vitamin D for osteoporotic fracture risk. Lancet. 2007;370(9588):632–4. doi:10.1016/S0140-6736(07)61315-4.CrossRefPubMed

15.

Lotters FJ, Lenoir-Wijnkoop I, Fardellone P, Rizzoli R, Rocher E, Poley MJ. Dairy foods and osteoporosis: an example of assessing the health-economic impact of food products. Osteoporos Int. 2013;24(1):139–50. doi:10.1007/s00198-012-1998-6.PubMedCentralCrossRefPubMed

16.

Hiligsmann M, Ethgen O, Bruyere O, Richy F, Gathon HJ, Reginster JY. Development and validation of a Markov microsimulation model for the economic evaluation of treatments in osteoporosis. Value Health. 2009;12(5):687–96. doi:10.1111/j.1524-4733.2008.00497.x.CrossRefPubMed

17.

Hiligsmann M, Vanoverberghe M, Neuprez A, Bruyere O, Reginster JY. Cost-effectiveness of strontium ranelate for the prevention and treatment of osteoporosis. Expert Rev Pharmacoecon Outcomes Res. 2010;10(4):359–66. doi:10.1586/erp.10.53.CrossRefPubMed

18.

Hiligsmann M, Reginster JY. Cost effectiveness of denosumab compared with oral bisphosphonates in the treatment of post-menopausal osteoporotic women in Belgium. PharmacoEconomics. 2011;29(10):895–911. doi:10.2165/11539980-000000000-00000.CrossRefPubMed

19.

Ethgen O, Standaert B. Population- versus cohort-based modelling approaches. PharmacoEconomics. 2012;30(3):171–81. doi:10.2165/11593050-000000000-00000.CrossRefPubMed

20.

SPF Economie - Direction Générale Statistique et Information Economique. http://economie.fgov.be/fr/modules/publications/statistiques/economie/prix_a_la_consommation_a_partir_de_1920_et_indice_sante_a_partir_de_1994.jsp.

21.

SPF Economie - Direction Générale Statistique et Information Economique. http://statbel.fgov.be/fr/modules/publications/statistiques/population/downloads/population_au_1er_janvier_2014-2061.jsp.

22.

Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, et al. Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med. 2010;152(6):380–90. doi:10.7326/0003-4819-152-6-201003160-00008.PubMedCentralCrossRefPubMed

23.

Hiligsmann M, Bruyere O, Roberfroid D, Dubois C, Parmentier Y, Carton J, et al. Trends in hip fracture incidence and in the prescription of antiosteoporosis medications during the same time period in Belgium (2000–2007). Arthritis Res. 2012;64(5):744–50. doi:10.1002/acr.21607.CrossRef

24.

Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int. 2000;11(8):669–74.CrossRefPubMed

25.

Klotzbuecher CM, Ross PD, Landsman PB, Abbott 3rd TA, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000;15(4):721–39. doi:10.1359/jbmr.2000.15.4.721.CrossRefPubMed

26.

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, et al. A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004;35(2):375–82. doi:10.1016/j.bone.2004.03.024.CrossRefPubMed

27.

Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P. Need for additional calcium to reduce the risk of hip fracture with vitamin d supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab. 2007;92(4):1415–23. doi:10.1210/jc.2006-1404.CrossRefPubMed

28.

Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007;370(9588):657–66. doi:10.1016/S0140-6736(07)61342-7.CrossRefPubMed

29.

Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. 2009;169(6):551–61. doi:10.1001/archinternmed.2008.600.CrossRefPubMed

30.

Cleemput I, van Wilder P, Huybrechts M, Vrijens F. Belgian methodological guidelines for pharmacoeconomic evaluations: toward standardization of drug reimbursement requests. Value Health. 2009;12(4):441–9. doi:10.1111/j.1524-4733.2008.00469.x.CrossRefPubMed

31.

Autier P, Haentjens P, Bentin J, Baillon JM, Grivegnee AR, Closon MC, et al. Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int. 2000;11(5):373–80.CrossRefPubMed

32.

Melton 3rd LJ, Gabriel SE, Crowson CS, Tosteson AN, Johnell O, Kanis JA. Cost-equivalence of different osteoporotic fractures. Osteoporos Int. 2003;14(5):383–8. doi:10.1007/s00198-003-1385-4.CrossRefPubMed

33.

Walensky RP, Ross EL, Kumarasamy N, Wood R, Noubary F, Paltiel AD, et al. Cost-effectiveness of HIV treatment as prevention in serodiscordant couples. N Engl J Med. 2013;369(18):1715–25. doi:10.1056/NEJMsa1214720.PubMedCentralCrossRefPubMed

34.

Gomez JA, Lepetic A, Demarteau N. Health economic analysis of human papillomavirus vaccines in women of Chile: perspective of the health care payer using a Markov model. BMC Public Health. 2014;14:1222. doi:10.1186/1471-2458-14-1222.PubMedCentralCrossRefPubMed

35.

Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726–33. doi:10.1007/s00198-006-0172-4.CrossRefPubMed

36.

Hiligsmann M, Evers SM, Ben Sedrine W, Kanis JA, Ramaekers B, Reginster JY, et al. A systematic review of cost-effectiveness analyses of drugs for postmenopausal osteoporosis. PharmacoEconomics. 2015;33(3):205–24. doi:10.1007/s40273-014-0231-1.CrossRefPubMed

37.

Rodriguez Barrios JM, Perez Alcantara F, Crespo Palomo C, Gonzalez Garcia P, Anton De Las Heras E, Brosa Riestra M. The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications. Eur J Health Econ. 2012;13(6):723–40. doi:10.1007/s10198-011-0326-y.CrossRefPubMed

38.

Azimi NA, Welch HG. The effectiveness of cost-effectiveness analysis in containing costs. J Gen Intern Med. 1998;13(10):664–9.PubMedCentralCrossRefPubMed

39.

Laupacis A, Feeny D, Detsky AS, Tugwell PX. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992;146(4):473–81.PubMedCentralPubMed

40.

Owens DK. Interpretation of cost-effectiveness analyses. J Gen Intern Med. 1998;13(10):716–7.CrossRefPubMed

41.

World Health Organization (WHO). Choosing interventions that are cost effective. Available at http://www.who.int/choice/costs/CER_thresholds/en/index.html. Accessed 25 Apr 2009.

42.

Kanis JA, Johansson H, Oden A, De Laet C, Johnell O, Eisman JA, et al. A meta-analysis of milk intake and fracture risk: low utility for case finding. Osteoporos Int. 2005;16(7):799–804. doi:10.1007/s00198-004-1755-6.CrossRefPubMed

43.

Michaelsson K, Wolk A, Langenskiold S, Basu S, Warensjo Lemming E, Melhus H, et al. Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ. 2014;349:g6015. doi:10.1136/bmj.g6015.PubMedCentralCrossRefPubMed

44.

van den Berg P, van Haard PM, van den Bergh JP, Niesten DD, van der Elst M, Schweitzer DH. First quantification of calcium intake from calcium-dense dairy products in Dutch fracture patients (the Delft cohort study). Nutrients. 2014;6(6):2404–18. doi:10.3390/nu6062404.PubMedCentralCrossRefPubMed

45.

Wlodarek D, Glabska D, Kolota A, Adamczyk P, Czekajlo A, Grzeszczak W, et al. Calcium intake and osteoporosis: the influence of calcium intake from dairy products on hip bone mineral density and fracture incidence - a population-based study in women over 55 years of age. Public Health Nutr. 2014;17(2):383–9. doi:10.1017/S1368980012005307.CrossRefPubMed

46.

Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Kanis JA, Orav EJ, Staehelin HB, et al. Milk intake and risk of hip fracture in men and women: a meta-analysis of prospective cohort studies. J Bone Miner Res. 2011;26(4):833–9. doi:10.1002/jbmr.279.CrossRefPubMed

47.

Grey A, Bolland M. Web of industry, advocacy, and academia in the management of osteoporosis. BMJ. 2015;351:h3170. doi:10.1136/bmj.h3170.CrossRefPubMed

48.

Bolland MJ, Grey A, Reid IR. Calcium supplements and cardiovascular risk in the Women’s Health Initiative. Osteoporos Int. 2013;24(8):2371–2. doi:10.1007/s00198-013-2356-z.CrossRefPubMed

49.

Paik JM, Curhan GC, Sun Q, Rexrode KM, Manson JE, Rimm EB, et al. Calcium supplement intake and risk of cardiovascular disease in women. Osteoporos Int. 2014;25(8):2047–56. doi:10.1007/s00198-014-2732-3.PubMedCentralCrossRefPubMed

50.

Kalkwarf HJ, Khoury JC, Lanphear BP. Milk intake during childhood and adolescence, adult bone density, and osteoporotic fractures in US women. Am J Clin Nutr. 2003;77(1):257–65.PubMed

51.

Heaney RP. Dairy and bone health. J Am Coll Nutr. 2009;28 Suppl 1:82S–90S.CrossRefPubMed

52.

Rizzoli R. Dairy products, yogurts, and bone health. Am J Clin Nutr. 2014;99(5 Suppl):1256S–62S. doi:10.3945/ajcn.113.073056.CrossRefPubMed

53.

Fernandez-Barres S, Martin N, Canela T, Garcia-Barco M, Basora J, Arija V et al. Dietary intake in the dependent elderly: evaluation of the risk of nutritional deficit. J Hum Nutr Diet 2015. doi:10.1111/jhn.12310

54.

Lekkerkerker F, Kanis JA, Alsayed N, Bouvenot G, Burlet N, Cahall D, et al. Adherence to treatment of osteoporosis: a need for study. Osteoporos Int. 2007;18(10):1311–7. doi:10.1007/s00198-007-0410-4.CrossRefPubMed

55.

Prince RL, Devine A, Dhaliwal SS, Dick IM. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med. 2006;166(8):869–75. doi:10.1001/archinte.166.8.869.CrossRefPubMed

56.

Hiligsmann M, Boonen A, Rabenda V, Reginster JY. The importance of integrating medication adherence into pharmacoeconomic analyses: the example of osteoporosis. Expert Rev Pharmacoecon Outcomes Res. 2012;12(2):159–66. doi:10.1586/erp.12.8.CrossRefPubMed

57.

Chen P, Hu P, Xie D, Qin Y, Wang F, Wang H. Meta-analysis of vitamin D, calcium and the prevention of breast cancer. Breast Cancer Res Treat. 2010;121(2):469–77. doi:10.1007/s10549-009-0593-9.CrossRefPubMed

58.

Murphy N, Norat T, Ferrari P, Jenab M, Bueno-de-Mesquita B, Skeie G, et al. Consumption of dairy products and colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). PLoS One. 2013;8(9), e72715. doi:10.1371/journal.pone.0072715.PubMedCentralCrossRefPubMed

59.

Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev. 2014;1:CD007470. doi:10.1002/14651858.CD007470.pub3.PubMed

Title: Public health impact and cost-effectiveness of dairy products supplemented with vitamin D in prevention of osteoporotic fractures
Authors: Olivier Ethgen
Mickaël Hiligsmann
Nansa Burlet
Jean-Yves Reginster
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Archives of Public Health / Issue 1/2015
Electronic ISSN: 2049-3258
DOI: https://doi.org/10.1186/s13690-015-0099-3

At a glance: The STEP trials

Springer Medicine

Public health impact and cost-effectiveness of dairy products supplemented with vitamin D in prevention of osteoporotic fractures

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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