OSTEOPOROSIS - THE NEED FOR COMPREHENSIVE TREATMENT GUIDELINES

Osteoporosis is a debilitating disease that results in nearly 1.3 mill ion fractures per year in the United States. The cost of treating thes e fractures has been estimated to be as high as $10 billion per year. These costs are expected to more than double during the next 50 years unless comprehensive programs of prevention and treatment are initiate d. Both pharmacologic and nonpharmacologic interventions (eg, diet and exercise) have been shown to have a significant impact on the inciden ce of osteoporosis, depending on the time of their application. Unfort unately, osteoporosis is often not diagnosed until after fractures hav e occurred, when it may be too late for treatment to have a major impa ct. To be most effective, therapy should be started early, before seri ous bone loss has occurred. Because of its efficacy and relatively low acquisition cost, long-term hormone replacement therapy (HRT) is cons idered first-line pharmacologic therapy for the prevention of osteopor osis. However, for various reasons, less than 25% of US women who migh t benefit from HRT are receiving it. Aside from HRT, the only other pr oducts approved by the US Food and Drug Administration for the treatme nt of osteoporosis are salmon calcitonin and alendronate. Several othe r agents are under development, including sustained-release fluoride a nd other products in the bisphosphonate class. The development and ado ption of early detection programs and treatment guidelines are crucial to help ease the economic burden of osteoporosis. These guidelines sh ould incorporate preventive measures such as diet and exercise, risk a ssessment through proper screening programs, and the appropriate use o f pharmaceutical products. The purpose of this paper is to discuss rel evant economic issues associated with osteoporosis and discuss the nee d for a management algorithm that could be used to more efficiently pr event and treat this disease. We conclude that further modeling is nee ded to determine which programs and treatments are most cost-effective within each at-risk subgroup. As clinicians better understand the nee d for preventive care and the advantages of the various pharmacologic therapies, patients with osteoporosis will receive higher-quality and more efficient medical care.