We assessed the cost-effectiveness of daily calcium supplementation for the
prevention of primary osteoporotic hip fractures. The assessment was based
on our meta-analysis of the published relative-risk estimates from 3 doubl
e-masked, placebo-controlled, clinical trials and our analysis of raw data
from the National Health and Nutrition Examination Survey 1988-1994 on the
daily intake of calcium supplements by adults in the United States. These d
ata were then used to estimate the preventable proportion of hip fractures.
The 1995 National Hospital Discharge Survey database provided the number a
nd demographic characteristics of patients discharged with a primary diagno
sis of hip fracture, as well as their discharge destination. The 1990 itemi
zed costs of hip fractures, as estimated by the US Congress Office of Techn
ology Assessment, were inflated to 1995 dollars using the medical care comp
onent of the Consumer Price Index. Using these inflated itemized costs, we
then estimated the weighted average expenditures, reflecting both the types
of services associated with specific hospital-discharge destinations and t
he demographic characteristics of discharged patients. The cost of suppleme
nts containing 1200 mg/d of elemental calcium for the mean duration (34 mon
ths) of the 3 clinical trials was calculated on the basis of 1998 unit-pric
e and market-share data for 6 representative products. For 1995, the data i
ndicate that 290,327 patients aged greater than or equal to 50 years were d
ischarged from US hospitals with a primary diagnosis of hip fracture, at ou
r estimated direct cost of $5.6 billion. Based on the risk reductions seen
in the 3 trials, we estimated that 134,764 hip fractures and $2.6 billion i
n direct medical costs could have been avoided if individuals aged greater
than or equal to 50 years consumed approximately 1200 mg/d of supplemental
calcium. Additional savings could be expected, because this intervention is
also associated with significant reductions in the risk for all nonvertebr
al fractures. Comparing the cost of calcium with the expected medical savin
gs from hip fractures avoided, it is cost-effective to give 34 months of ca
lcium supplementation to women aged greater than or equal to 75 years in th
e United States. If, as the published studies suggest, shorter periods of s
upplementation result in an equivalent reduction in the risk of hip fractur
es, calcium supplementation becomes cost-effective for all adults aged grea
ter than or equal to 65 years in the United States. The data support encour
aging older adults to increase their intake of dietary calcium and to consi
der taking a daily calcium supplement. Even small increases in the usage ra
te of supplementation are predicted to yield significant savings and to red
uce the morbidity and mortality associated with hip fracture at an advanced
age.