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Veronese N, Briot K, Guañabens N, Albergaria BH, Alokail M, Al-Daghri N, Bemden ABV, Bruyère O, Burlet N, Cooper C, Curtis EM, Ebeling PR, Halbout P, Hesse E, Hiligsmann M, Camargos BM, Harvey NC, Perez AD, Radermecker RP, Reginster JY, Rizzoli R, Siggelkow H, Cortet B, Brandi ML. Recommendations for the optimal use of bone forming agents in osteoporosis. Aging Clin Exp Res 2024; 36:167. [PMID: 39120740 PMCID: PMC11315730 DOI: 10.1007/s40520-024-02826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
Bone forming agents, also known as anabolic therapies, are essential in managing osteoporosis, particularly for patients at very high-risk of fractures. Identifying candidates who will benefit the most from these treatments is crucial. For example, this group might include individuals with severe osteoporosis, multiple vertebral fractures, a recent fragility fracture or those unresponsive to antiresorptive treatments. Definitions of patients with a very high fracture risk vary across nations, are often based on fracture history, bone mineral density (BMD), and/or fracture risk calculated by FRAX® or other algorithms. However, for very high-risk patients, anabolic agents such as teriparatide, abaloparatide, or romosozumab are commonly recommended as first-line therapies due to their ability to stimulate new bone formation and improve bone microarchitecture, offering significant benefits in rapid fracture reduction over antiresorptive therapies. The cost-effectiveness of these agents is a critical consideration for decision-makers. Despite their higher costs, their effectiveness in significantly reducing fracture risk and improving quality of life can justify the investment, especially when long-term savings from reduced fracture rates and associated healthcare costs are considered. Additionally, after completing a course of anabolic therapy, transitioning to antiresorptive agents like bisphosphonates or denosumab is crucial to maintain the gains in bone density and minimize subsequent fracture risks. This sequential treatment approach ensures sustained protection and optimal resource utilization. In summary, the effective use of bone forming agents in osteoporosis requires a comprehensive strategy that includes accurate patient identification, consideration of cost-effectiveness, and implementation of appropriate sequential treatments, ultimately maximizing patient outcomes and healthcare efficiency.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127, Palermo, Italy.
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia.
| | - Karine Briot
- AP-HP, Department of Rheumatology, Cochin Hospital, Paris, France
| | - Nuria Guañabens
- Rheumatology Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Ben Hur Albergaria
- Department of Social Medicine (Clinical Epidemiology), Federal University of Espirito Santo, Vitória, Brazil
| | - Majed Alokail
- Protein Research Chair, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, 11451, Riyadh, Kingdom of Saudi Arabia
| | - Angie Botto-van Bemden
- Global Patient Ambassador, Musculoskeletal Research International, Inc., Miami, FL, USA
- Patient Partner, Holiday, FL, USA
- EUPATI Fellow, Holiday, FL, USA
- Clinical Research Experts, LLC., Tampa, FL, USA
| | - Olivier Bruyère
- Research Unit in Public Health, Epidemiology and Health Economics, Department Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Nansa Burlet
- Research Unit in Public Health, Epidemiology and Health Economics, Department Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Department of Endocrinology, Monash University, Clayton, VIC, Australia
| | | | - Eric Hesse
- Institute of Musculoskeletal Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- Musculoskeletal University Center Munich, LMU University Hospital, LMU Munich, Munich, Germany
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Bruno Muzzi Camargos
- Department of Radiology - Densitometry, Rede Materdei de Saúde, Belo Horizonte, Minas Gerais, Brazil
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Adolfo Diez Perez
- Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liege, CHU de Liège, Liège, Belgium
| | - Jean-Yves Reginster
- Protein Research Chair, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Heide Siggelkow
- Department of Trauma, Orthopedics and Reconstructive Surgery, MVZ Endokrinologikum Göttingen, University Medical Center Goettingen, Von-Siebold-Straße 3, Robert-Koch-Straße 40, 37075, Goettingen, Germany
| | - Bernard Cortet
- Department of Rheumatology and ULR 44490, University-Hospital of Lille, 59037, Lille Cedex, France
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Hiligsmann M, Silverman SL, Singer AJ, Pearman L, Wang Y, Caminis J, Reginster JY. Comparison of the cost-effectiveness of sequential treatment with abaloparatide in US men and women at very high risk of fractures. Aging Clin Exp Res 2024; 36:14. [PMID: 38289413 PMCID: PMC10827834 DOI: 10.1007/s40520-023-02682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Osteoporotic-related fractures represent an increasing burden to patients, health care systems and society. AIMS This study estimated cost-effectiveness of sequential treatment with abaloparatide (ABL) followed by alendronate (ALN) compared to relevant alternative strategies in US men and women aged 50 to 80 years at very high fracture risk (bone mineral density T-score ≤ - 2.5 and a recent fracture). METHODS A lifetime Markov-based microsimulation model was used to estimate healthcare costs and quality-adjusted life years (QALYs). Comparators were sequential treatment with unbranded teriparatide (TPTD)/ALN, generic ALN monotherapy, and no treatment. Analyses were conducted based on initial fracture site (hip, vertebral, or any fracture) and treatment efficacy data (derived from clinical trials or a recent network meta-analysis). RESULTS From all analyses completed, sequential ABL/ALN demonstrated more QALYs for lower healthcare costs versus unbranded TPTD/ALN. No treatment was dominated (higher costs for less QALYs) versus ALN monotherapy. Sequential ABL/ALN resulted in favorable cost-effectiveness (at US threshold of $150,000/QALY) versus generic ALN monotherapy in men aged ≥ 50 years with any fracture type, women aged ≥ 65 years with any fracture type, and women aged ≥ 55 years having a hip or vertebral fracture. DISCUSSION Similar cost-effectiveness of sequential ABL/ALN versus unbranded TPTD/ALN, ALN monotherapy, and no treatment was observed in both US men and women at very high fracture risk, with a moderate improvement in cost-effectiveness in men versus women and in patients with a hip or vertebral fracture. CONCLUSIONS Sequential therapy with ABL/ALN was cost-effective in US men and women at very high risk of fractures.
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Affiliation(s)
- Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Stuart L Silverman
- Cedars-Sinai Medical Center, Los Angeles and the OMC Clinical Research Center, Beverly Hills, CA, USA
| | - Andrea J Singer
- MedStar Georgetown University Hospital and Georgetown University Medical Center, Washington, DC, USA
| | | | | | | | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- World Health Organization Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium
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