Osteoporosis Drug Class Reduces Hip Fracture Rate, But at a High Cost

The high cost of bisphosphonates may outweigh the drugs’ benefit in reducing hip fracture rates.

For a poster presented at the American Academy of Orthopaedic Surgeons 2015 Annual Meeting in Las Vegas, a team of researchers aimed to better understand the cost-benefit ratio of routine bisphosphonate treatment for distal radius fractures related to osteoporosis in women aged older than 65 years.

As study co-author Asif M. Ilyas, MD, explained to Pharmacy Times in an e-mail, little is known about the cost of such drug therapy in a treatment program designed to avoid more serious osteoporotic fractures in the future.

Through their cost-benefit analysis, the researchers predicted more than 350,000 lifetime hip fractures following wrist fractures in all women aged 65 years or older. If these patients had initiated bisphosphonate treatment, however, the number of hip fractures over their lifetimes would drop to around 260,000. But, the researchers cautioned, about 20,000 patients would suffer from an atypical fracture, such as a femur fracture, as a result of that treatment.

“The benefits of bisphosphonates are well established,” Dr. Ilyas told Pharmacy Times. “However, routine prescribing of bisphosphonates must be done with the understanding of the high cost to the patient and society at its current price index.”

The total lifetime treatment cost was estimated at about $19.5 billion, which breaks down to about $205,534 per avoided hip fracture. The investigators determined that the break-even price point of annual bisphosphonate therapy after wrist fracture for the prevention of hip fractures would be about $70 per patient—a steep drop from the current average annual wholesale cost of $1485 per patient.

“The study findings should primary alert [pharmacists] to the high costs of routine treatment of osteoporosis and the controversial cost-benefit analysis,” Dr. Ilyas told Pharmacy Times. “The study provides greater economic perspective to pharmacists, which can be of value when they counsel their patients.”