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Ankle fractures do not predict osteoporotic fractures in women with or without diabetes.

https://arctichealth.org/en/permalink/ahliterature134581
Source
Osteoporos Int. 2012 Mar;23(3):957-62
Publication Type
Article
Date
Mar-2012
Author
J M Pritchard
L M Giangregorio
G. Ioannidis
A. Papaioannou
J D Adachi
W D Leslie
Author Affiliation
Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. pritcjm@mcmaster.ca
Source
Osteoporos Int. 2012 Mar;23(3):957-62
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Aged
Ankle Injuries - epidemiology - physiopathology
Body mass index
Bone Density - physiology
Diabetes Mellitus - epidemiology
Female
Fractures, Bone - epidemiology - physiopathology
Humans
Manitoba - epidemiology
Middle Aged
Osteoporosis, Postmenopausal - complications - diagnosis - epidemiology - physiopathology
Osteoporotic Fractures - epidemiology - etiology - physiopathology
Risk factors
Abstract
It is not clear whether ankle fractures predict future osteoporotic fractures in women, and whether diabetes influences this relationship. We found that a prior ankle fracture does not predict subsequent osteoporotic fractures in women with or without diabetes.
We aimed to determine: (1) whether a prior ankle fracture was a risk factor for a subsequent major osteoporotic fracture in older women; (2) whether this risk was modified by the presence of diabetes; (3) the risk factors for ankle fracture in older women.
We identified 3,054 women age 50 years and older with diabetes and 9,151 matched controls using the Manitoba Bone Density Program database. Multivariable regression models were used to examine factors associated with prior ankle fracture, and the importance of prior ankle fracture as a predictor of subsequent major osteoporotic fracture during a mean 4.8 years of observation.
A prior ankle fracture was not a significant predictor of subsequent major osteoporotic fracture for women with diabetes (hazard ratio [HR] 1.13; 95% confidence interval [CI], 0.68-1.83; p = 0.623) or women without diabetes (HR 1.16; 95% CI, 0.79-1.71; p = 0.460), and there was no interaction between diabetes and ankle fracture after pooling all women in the cohort (p = 0.971). The presence of diabetes was not independently associated with prior ankle fracture (adjusted odds ratio [OR] 1.14 [95% CI, 0.93-1.38], p = 0.200), whereas higher body mass index (adjusted OR 1.04 per standard deviation increase [95% CI, 1.03-1.06], p 6 ambulatory diagnostic groups) (adjusted OR 1.81 [95% CI, 1.40-2.36], p
PubMed ID
21562874 View in PubMed
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Association of larger holes in the trabecular bone at the distal radius in postmenopausal women with type 2 diabetes mellitus compared to controls.

https://arctichealth.org/en/permalink/ahliterature128269
Source
Arthritis Care Res (Hoboken). 2012 Jan;64(1):83-91
Publication Type
Article
Date
Jan-2012
Author
Janet M Pritchard
Lora M Giangregorio
Stephanie A Atkinson
Karen A Beattie
Dean Inglis
George Ioannidis
Zubin Punthakee
J D Adachi
Alexandra Papaioannou
Author Affiliation
McMaster University, Hamilton, Ontario, Canada.
Source
Arthritis Care Res (Hoboken). 2012 Jan;64(1):83-91
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Aged
Bone Density
Case-Control Studies
Cross-Sectional Studies
Diabetes Mellitus, Type 2 - complications - pathology - radiography
Female
Femur Neck - pathology - radiography
Fractures, Bone - etiology - pathology
Humans
Linear Models
Lumbar Vertebrae - pathology - radiography
Magnetic Resonance Imaging
Odds Ratio
Ontario
Osteoporosis, Postmenopausal - complications - pathology - radiography
Radius - pathology
Risk assessment
Risk factors
Abstract
Adults with type 2 diabetes mellitus (DM) have an elevated fracture risk despite normal areal bone mineral density (aBMD). The study objective was to compare trabecular bone microarchitecture of postmenopausal women with type 2 DM and women without type 2 DM.
An extremity 1T magnetic resonance imaging system was used to acquire axial images (195 × 195 × 1,000 µm(3) voxel size) of the distal radius of women recruited from outpatient clinics or by community advertisement. Image segmentation yielded geometric, topologic, and stereologic outcomes, i.e., number and size of trabecular bone network holes (marrow spaces), endosteal area, trabecular bone volume fraction, nodal and branch density, and apparent trabecular thickness, separation, and number. Lumbar spine (LS) and proximal femur BMD were measured with dual x-ray absorptiometry. Microarchitectural differences were assessed using linear regression and adjusted for percent body fat, ethnicity, timed up-and-go test, Charlson Index, and calcium and vitamin D intake; aBMD differences were adjusted for body mass index (BMI).
Women with type 2 DM (n = 30, mean ± SD age 71.0 ± 4.8 years) had larger holes (+13.3%; P = 0.001) within the trabecular bone network than women without type 2 DM (n = 30, mean ± SD age 70.7 ± 4.9 years). LS aBMD was greater in women with type 2 DM; however, after adjustment for BMI, LS aBMD did not differ between groups.
In women with type 2 DM, the average hole size within the trabecular bone network at the distal radius is greater compared to controls. This may explain the elevated fracture risk in this population.
Notes
Erratum In: Arthritis Care Res (Hoboken). 2012 Jun;64(6):944
PubMed ID
22213724 View in PubMed
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Associations among disease conditions, bone mineral density, and prevalent vertebral deformities in men and women 50 years of age and older: cross-sectional results from the Canadian Multicentre Osteoporosis Study.

https://arctichealth.org/en/permalink/ahliterature186024
Source
J Bone Miner Res. 2003 Apr;18(4):784-90
Publication Type
Article
Date
Apr-2003
Author
D A Hanley
J P Brown
A. Tenenhouse
W P Olszynski
G. Ioannidis
C. Berger
J C Prior
L. Pickard
T M Murray
T. Anastassiades
S. Kirkland
C. Joyce
L. Joseph
A. Papaioannou
S A Jackson
S. Poliquin
J D Adachi
Author Affiliation
Department of Medicine, University of Calgary. Calgary, Alberta, Canada. dahanley@ucalgary.ca
Source
J Bone Miner Res. 2003 Apr;18(4):784-90
Date
Apr-2003
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Bone Density
Canada - epidemiology
Cohort Studies
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 2 - complications
Female
Humans
Hypertension - complications
Kidney Calculi - complications
Male
Middle Aged
Osteitis Deformans - complications
Osteoporosis - complications - epidemiology
Spine - abnormalities
Abstract
This cross-sectional cohort study of 5566 women and 2187 men 50 years of age and older in the population-based Canadian Multicentre Osteoporosis Study was conducted to determine whether reported past diseases are associated with bone mineral density or prevalent vertebral deformities. We examined 12 self-reported disease conditions including diabetes mellitus (types 1 or 2), nephrolithiasis, hypertension, heart attack, rheumatoid arthritis, thyroid disease, breast cancer, inflammatory bowel disease, neuromuscular disease, Paget's disease, and chronic obstructive pulmonary disease. Multivariate linear and logistic regression analyses were performed to determine whether there were associations among these disease conditions and bone mineral density of the lumbar spine, femoral neck, and trochanter, as well as prevalent vertebral deformities. Bone mineral density measurements were higher in women and men with type 2 diabetes compared with those without after appropriate adjustments. The differences were most notable at the lumbar spine (+0.053 g/cm2), femoral neck (+0.028 g/cm2), and trochanter (+0.025 g/cm2) in women, and at the femoral neck (+0.025 g/cm2) in men. Hypertension was also associated with higher bone mineral density measurements for both women and men. The differences were most pronounced at the lumbar spine (+0.022 g/cm2) and femoral neck (+0.007 g/cm2) in women and at the lumbar spine (+0.028 g/cm2) in men. Although results were statistically inconclusive, men reporting versus not reporting past nephrolithiasis appeared to have clinically relevant lower bone mineral density values. Bone mineral density differences were -0.022, -0.015, and -0.016 g/cm2 at the lumbar spine, femoral neck, and trochanter, respectively. Disease conditions were not strongly associated with vertebral deformities. In summary, these cross-sectional population-based data show that type 2 diabetes and hypertension are associated with higher bone mineral density in women and men, and nephrolithiasis may be associated with lower bone mineral density in men. The importance of these associations for osteoporosis case finding and management require further and prospective studies.
PubMed ID
12674340 View in PubMed
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The burden of illness of osteoporosis in Canada.

https://arctichealth.org/en/permalink/ahliterature126333
Source
Osteoporos Int. 2012 Nov;23(11):2591-600
Publication Type
Article
Date
Nov-2012
Author
J-E Tarride
R B Hopkins
W D Leslie
S. Morin
J D Adachi
A. Papaioannou
L. Bessette
J P Brown
R. Goeree
Author Affiliation
Programs for Assessment of Technology in Health (PATH) Research Institute, St Joseph's Healthcare Hamilton, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada. tarride@mcmaster.ca
Source
Osteoporos Int. 2012 Nov;23(11):2591-600
Date
Nov-2012
Language
English
Publication Type
Article
Keywords
Aged
Bone Density Conservation Agents - economics - therapeutic use
Canada - epidemiology
Cost of Illness
Drug Costs - statistics & numerical data
Emergency Service, Hospital - economics - statistics & numerical data
Female
Health Care Costs - statistics & numerical data
Home Care Services - economics - statistics & numerical data
Hospitalization - economics - statistics & numerical data
Humans
Long-Term Care - economics
Male
Middle Aged
Osteoporosis - economics - epidemiology - therapy
Osteoporotic Fractures - economics - epidemiology - therapy
Prevalence
Sensitivity and specificity
Abstract
To update the 1993 burden of illness of osteoporosis in Canada, administrative and community data were used to calculate the 2010 costs of osteoporosis at $2.3 billion in Canada or 1.3% of Canada's healthcare expenditures. Prevention of fractures in high-risk individuals is key to decrease the financial burden of osteoporosis.
Since the 1996 publication of the burden of osteoporosis in 1993 in Canada, the population has aged and the management of osteoporosis has changed. The study purpose was to estimate the current burden of illness due to osteoporosis in Canadians aged 50 and over.
Analyses were conducted using five national administrative databases from the Canadian Institute for Health Information for the fiscal-year ending March 31 2008 (FY 2007/2008). Gaps in national data were supplemented by provincial and community data extrapolated to national levels. Osteoporosis-related fractures were identified using a combination of most responsible diagnosis at discharge and intervention codes. Fractures associated with severe trauma codes were excluded. Costs, expressed in 2010 dollars, were calculated for osteoporosis-related hospitalizations, emergency care, same day surgeries, rehabilitation, continuing care, homecare, long-term care, prescription drugs, physician visits, and productivity losses. Sensitivity analyses were conducted to measure the impact on the results of key assumptions.
Osteoporosis-related fractures were responsible for 57,413 acute care admissions and 832,594 hospitalized days in FY 2007/2008. Acute care costs were estimated at $1.2 billion. When outpatient care, prescription drugs, and indirect costs were added, the overall yearly cost of osteoporosis was over $2.3 billion for the base case analysis and as much as $3.9 billion if a proportion of Canadians were assumed to be living in long-term care facilities due to osteoporosis.
Osteoporosis is a chronic disease that affects a large segment of the adult population and results in a substantial economic burden to the Canadian society.
Notes
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PubMed ID
22398854 View in PubMed
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Canadian normative data for the SF-36 health survey. Canadian Multicentre Osteoporosis Study Research Group.

https://arctichealth.org/en/permalink/ahliterature197488
Source
CMAJ. 2000 Aug 8;163(3):265-71
Publication Type
Article
Date
Aug-8-2000
Author
W M Hopman
T. Towheed
T. Anastassiades
A. Tenenhouse
S. Poliquin
C. Berger
L. Joseph
J P Brown
T M Murray
J D Adachi
D A Hanley
E. Papadimitropoulos
Author Affiliation
MacKenzie Health Services Research Group, Queen's University, Kingston, Ont. hopmanw@post.queensu.ca
Source
CMAJ. 2000 Aug 8;163(3):265-71
Date
Aug-8-2000
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Age Distribution
Aged
Canada - epidemiology
Female
Great Britain - epidemiology
Health status
Health Status Indicators
Health Surveys
Humans
Male
Mental health
Middle Aged
Outcome Assessment (Health Care)
Prospective Studies
Quality of Life
Questionnaires
Reference Values
Sex Distribution
Socioeconomic Factors
United States - epidemiology
Urban health
Abstract
The Medical Outcomes Study 36-item Short Form (SF-36) is a widely used measure of health-related quality of life. Normative data are the key to determining whether a group or an individual scores above or below the average for their country, age or sex. Published norms for the SF-36 exist for other countries but have not been previously published for Canada.
The Canadian Multicentre Osteoporosis Study is a prospective cohort study involving 9423 randomly selected Canadian men and women aged 25 years or more living in the community. The sample was drawn within a 50-km radius of 9 Canadian cities, and the information collected included the SF-36 as a measure of health-related quality of life. This provided a unique opportunity to develop age- and sex-adjusted normative data for the Canadian population.
Canadian men scored substantially higher than women on all 8 domains and the 2 summary component scales of the SF-36. Canadians scored higher than their US counterparts on all SF-36 domains and both summary component scales and scored higher than their UK counterparts on 4 domains, although many of the differences are not large.
The differences in the SF-36 scores between age groups, sexes and countries confirm that these Canadian norms are necessary for comparative purposes. The data will be useful for assessing the health status of the general population and of patient populations, and the effect of interventions on health-related quality of life.
Notes
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Comment In: CMAJ. 2000 Aug 8;163(3):283-410951725
PubMed ID
10951722 View in PubMed
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A Canadian survey on the management of corticosteroid induced osteoporosis by rheumatologists.

https://arctichealth.org/en/permalink/ahliterature198242
Source
J Rheumatol. 2000 Jun;27(6):1506-12
Publication Type
Article
Date
Jun-2000
Author
E. Soucy
N. Bellamy
J D Adachi
J E Pope
J. Flynn
E. Sutton
J. Campbell
Author Affiliation
Department of Medicine, University of Western Ontario, London, Canada.
Source
J Rheumatol. 2000 Jun;27(6):1506-12
Date
Jun-2000
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon - statistics & numerical data
Adrenal Cortex Hormones - adverse effects
Adult
Alendronate - therapeutic use
Bone Density
Calcitonin - therapeutic use
Canada
Data Collection
Etidronic Acid - therapeutic use
Female
Hormone Replacement Therapy
Humans
Middle Aged
Osteoporosis - chemically induced - drug therapy - prevention & control - radiography
Physician's Practice Patterns
Postmenopause
Practice Management, Medical
Premenopause
Questionnaires
Referral and Consultation - statistics & numerical data
Rheumatology - statistics & numerical data
Abstract
To survey the practice pattern of Canadian rheumatologists (CR) on their management of corticosteroid induced osteoporosis in their premenopausal (PrM) and postmenopausal (PoM) female patients.
The practice pattern was surveyed using a 17 item questionnaire probing the diagnosis, prevention, treatment, and monitoring of osteoporosis in PrM and PoM women receiving longterm oral systemic corticosteroid therapy.
Most CR investigated and treated osteoporosis themselves, 13% referred to other specialists for investigation, and 22% referred for treatment. Eighty-two percent of CR used dual energy x-ray absorptiometry (DEXA) to confirm a diagnosis of osteoporosis. Most CR initiated investigation for osteoporosis at the start or within the first year of starting longterm systemic corticosteroid therapy: PrM 87% and PoM 93%. The most frequently used initial strategy for the prevention of osteoporosis was as follows. PrM: calcium and vitamin D3 (53%); PoM: hormone replacement therapy (HRT) and calcium (29%). The most common initial choice for treatment of established osteoporosis was as follows: PrM: etidronate (53%); PoM: bisphosphonates +/- HRT (53%). Ninety-six percent of CR used only bone mineral density (BMD) measurement to monitor therapy for corticosteroid induced osteoporosis. Most CR monitored BMD every 12 to 24 months for PrM (81%) and PoM (84%). The BMD parameter(s) (T and Z scores as measured by DEXA) used to initiate therapy for corticosteroid induced osteoporosis was variable.
It appears that, while certain trends are evident, there is still considerable variability in the management of corticosteroid induced osteoporosis.
PubMed ID
10852279 View in PubMed
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A community-based clinical trial of Intra-Venous zOledRonic acid once Yearly in comparison to oral bisphosphonates in postmenopausal women with osteoporosis: the IVORY trial Methodological considerations.

https://arctichealth.org/en/permalink/ahliterature134044
Source
Contemp Clin Trials. 2011 Sep;32(5):741-6
Publication Type
Article
Date
Sep-2011
Author
Jacques P Brown
J D Adachi
D L Kendler
R. Rigal
G. Deutsch
J M Leclerc
Author Affiliation
Centre de recherche du CHUQ, CHUL, Laval University, Quebec City, Quebec, Canada. jacques.brown@crchul.ulaval.ca
Source
Contemp Clin Trials. 2011 Sep;32(5):741-6
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Bone Density Conservation Agents - therapeutic use
Canada
Chi-Square Distribution
Community Health Services - organization & administration
Diphosphonates - therapeutic use
Female
Humans
Imidazoles - therapeutic use
Multicenter Studies as Topic
Osteoporosis, Postmenopausal - prevention & control
Product Surveillance, Postmarketing - methods
Prospective Studies
Questionnaires
Risk
Risk assessment
Time Factors
Women's health
Abstract
Zoledronic acid is an intravenous once yearly bisphosphonate that has been shown to be effective and safe in improving BMD (bone mineral density) and reducing fracture risk in controlled clinical trials. IVORY is a Canadian post marketing study aiming at assessing real-life effectiveness, health care resource utilization, safety and compliance to treatment with zoledronic acid in comparison to orally administered bisphosphonates (OBP).
IVORY is a prospective two cohort observational study of patients treated with zoledronic acid or OBP. Eligible patients are postmenopausal females, >45 years old with osteoporosis for whom initiation of treatment with OBP or zoledronic acid is indicated. Subjects will be followed for four years. Outcomes are the change in lumbar spine, femoral neck and total hip BMD and the incidence of fractures. The study cohort will consist of 920 patients treated with zoledronic acid and 460 treated with OBP. Additional comparisons will be based on external standardization to the population of Quebec patients treated with OBP.
Post Marketing Observational Studies (PMOS) are essential for the assessment of real-life effectiveness and population based benefit-risk ratios. The effect of access to care, compliance, adherence to guidelines, patient comorbidity and concomitant medication use could only be assessed with observational studies. IVORY will provide information about true life effectiveness, benefit-risk ratios, cost-effectiveness and barriers to the process-outcome optimization. The results will have implications for decision makers and health care stakeholders regarding the management of osteoporosis in Canada.
PubMed ID
21628001 View in PubMed
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Construction of a FRAX® model for the assessment of fracture probability in Canada and implications for treatment.

https://arctichealth.org/en/permalink/ahliterature138602
Source
Osteoporos Int. 2011 Mar;22(3):817-27
Publication Type
Article
Date
Mar-2011
Author
W D Leslie
L M Lix
L. Langsetmo
C. Berger
D. Goltzman
D A Hanley
J D Adachi
H. Johansson
A. Oden
E. McCloskey
J A Kanis
Author Affiliation
University of Manitoba, Winnipeg, Canada. bleslie@sbgh.mb.ca
Source
Osteoporos Int. 2011 Mar;22(3):817-27
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon
Aged
Aged, 80 and over
Bone Density
Canada - epidemiology
Female
Femur Neck - radiography
Hip Fractures - epidemiology - rehabilitation
Humans
Male
Middle Aged
Multicenter Studies as Topic
Osteoporotic Fractures - epidemiology - rehabilitation
Risk Assessment - methods
Risk factors
Spinal Fractures - epidemiology
World Health Organization
Abstract
We describe the creation of a FRAX® model for the assessment of fracture probability in Canadian men and women, calibrated from national hip fracture and mortality data. This FRAX tool was used to examine possible thresholds for therapeutic intervention in Canada in two large complementary cohorts of women and men.
To evaluate a Canadian World Health Organization (WHO) fracture risk assessment (FRAX®) tool for computing 10-year probabilities of osteoporotic fracture.
Fracture probabilities were computed from national hip fracture data (2005) and death hazards (2004) for Canada. Probabilities took account of age, sex, clinical risk factors (CRFs), and femoral neck bone mineral density (BMD). Treatment implications were studied in two large cohorts of individuals age 50 years and older: the population-based Canadian Multicentre Osteoporosis Study (4,778 women and 1,919 men) and the clinically referred Manitoba BMD Cohort (36,730 women and 2,873 men).
Fracture probabilities increased with age, decreasing femoral neck T-score, and number of CRFs. Among women, 10.1-11.3% would be designated high risk based upon 10-year major osteoporotic fracture probability exceeding 20%. A much larger proportion would be designated high risk based upon 10-year hip fracture probability exceeding 3% (25.7-28.0%) or osteoporotic BMD (27.1-30.9%), and relatively few from prior hip or clinical spine fracture (1.6-4.2%). One or more criteria for intervention were met by 29.2-34.0% of women excluding hip fracture probability (35.3-41.0% including hip fracture probability). Lower intervention rates were seen among CaMos (Canadian Multicentre Osteoporosis Study) men (6.8-12.9%), but in clinically referred men from the Manitoba BMD Cohort, one or more criteria for high risk were seen for 26.4% excluding hip fracture probability (42.4% including hip fracture probability).
The FRAX tool can be used to identify intervention thresholds in Canada. The FRAX model supports a shift from a dual X-ray absorptiometry (DXA)-based intervention strategy, towards a strategy based on fracture probability for a major osteoporotic fracture.
PubMed ID
21161509 View in PubMed
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Cost-effectiveness of denosumab in the treatment of postmenopausal osteoporosis in Canada.

https://arctichealth.org/en/permalink/ahliterature120144
Source
J Med Econ. 2012;15 Suppl 1:3-14
Publication Type
Article
Date
2012
Author
D. Chau
D L Becker
M E Coombes
G. Ioannidis
J D Adachi
R. Goeree
Author Affiliation
Amgen Canada Inc, Mississauga, Ontario, Canada.
Source
J Med Econ. 2012;15 Suppl 1:3-14
Date
2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alendronate - economics - therapeutic use
Antibodies, Monoclonal, Humanized - economics - therapeutic use
Bone Density Conservation Agents - economics - therapeutic use
Cohort Studies
Cost-Benefit Analysis
Etidronic Acid - analogs & derivatives - economics - therapeutic use
Female
Humans
Markov Chains
Middle Aged
Models, Econometric
Ontario
Osteoporosis, Postmenopausal - drug therapy
Quality-Adjusted Life Years
Abstract
Denosumab is a novel biologic agent approved in Canada for treatment of post-menopausal osteoporosis (PMO) in women at high risk for fracture or who have failed or are intolerant to other osteoporosis therapies. This study estimated cost-effectiveness of denosumab vs usual care from the perspective of the Ontario public payer.
A previously published PMO Markov cohort model was adapted for Canada to estimate cost-effectiveness of denosumab. The primary analysis included women with demographic characteristics similar to those from the pivotal phase III denosumab PMO trial (FREEDOM; age 72 years, femoral neck BMD T-score -2.16 SD, vertebral fracture prevalence 23.6%). Three additional scenario sub-groups were examined including women: (1) at high fracture risk, defined in FREEDOM as having at least two of three risk factors (age 70+; T-score = -3.0 SD at lumbar spine, total hip, or femoral neck; prevalent vertebral fracture); (2) age 75+; and (3) intolerant or contraindicated to oral bisphosphonates (BPs). Analyses were conducted over a lifetime horizon comparing denosumab to usual care ('no therapy', alendronate, risedronate, or raloxifene [sub-group 3 only]). The analysis considered treatment-specific persistence and post-discontinuation residual efficacy, as well as treatment-specific adverse events. Both deterministic and probabilistic sensitivity analyses were conducted.
The multi-therapy comparisons resulted in incremental cost-effectiveness ratios for denosumab vs alendronate of $60,266 (2010 CDN$) (primary analysis) and $27,287 per quality-adjusted life year gained for scenario sub-group 1. Denosumab dominated all therapies in the remaining scenarios.
Key limitations include a lack of long-term, real-world, Canadian data on persistence with denosumab as well as an absence of head-to-head clinical data, leaving one to rely on meta-analyses based on trials comparing treatment to placebo.
Denosumab may be cost-effective compared to oral PMO treatments for women at high risk of fractures and those who are intolerant and/or contraindicated to oral BPs.
PubMed ID
23035625 View in PubMed
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Could a policy of provision of hip protectors to elderly nursing home residents result in cost savings in acute hip fracture care? The case of Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature165651
Source
Osteoporos Int. 2007 Jun;18(6):819-27
Publication Type
Article
Date
Jun-2007
Author
A M Sawka
A. Gafni
P. Boulos
K. Beattie
A. Papaioannou
A. Cranney
D A Hanley
J D Adachi
A. Cheung
E A Papadimitropoulos
L. Thabane
Author Affiliation
Division of Endocrinology and Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada.
Source
Osteoporos Int. 2007 Jun;18(6):819-27
Date
Jun-2007
Language
English
Publication Type
Article
Keywords
Aged
Cost Savings - statistics & numerical data
Cost-Benefit Analysis
Health Care Costs - statistics & numerical data
Hip Fractures - economics - epidemiology - prevention & control
Homes for the Aged
Humans
Nursing Homes
Ontario - epidemiology
Protective Devices - economics
Randomized Controlled Trials as Topic
Abstract
Hip fractures are an important problem in nursing homes. Hip protectors are external devices that decrease the risk of hip fracture in elderly nursing home residents. We estimated the overall healthcare cost savings from a hypothetical strategy of provision of hip protectors to elderly nursing home residents in Ontario, Canada. In a recent meta-analysis, we determined that a strategy of provision of hip protectors decreases the risk of hip fracture in nursing home residents.
Our objective was to determine whether the provision of hip protectors to all Ontario nursing home residents aged > or =65 years could result in cost savings, stemming from reductions in initial hospitalizations for hip fracture.
We conducted a cost analysis from a Ministry of Health perspective (one year cycle length). The efficacy of the intervention was estimated from a meta-analysis of randomized controlled trials.
A strategy of provision of hip protectors to all 60,775 elderly Ontario nursing home residents could result in an overall mean cost savings of 6.0 million Canadian dollars in one year (95% credibility interval, -26.4 million, 39.7 million), with a probability of cost savings of 0.63 (assuming no additional labor costs). In sensitivity analyses, decreasing hip protector price increased cost savings, whereas additional labor expenditures for application for hip protectors decreased cost savings.
In conclusion, if hip protectors can be provided to elderly Ontario nursing home residents without additional labor expenditures, there is a reasonable probability that such a strategy may result in healthcare cost savings.
PubMed ID
17221294 View in PubMed
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