ABSTRACT
We estimated the Cost Per Avoided Hip Fracture (CPAHF, millions Lira) by osteoporosis treatment, on the basis of a review on randomized controlled trials. Prevention with vitamin D3 in institutionalized elderly women is cost-neutral (CPAHF = -4; 95% CI = -9, +5). Prevention with alendronate in non-institutionalized women screened on bone mineral density generates doubts (CPAHF = 275; 95% CI = 146, 19.426). The cost-effectiveness analyses can strengthen or weaken conclusions of the clinical trials and discourage the use of economically unsustainable preventive treatments whose efficacy is unproven.
Subject(s)
Hip Fractures/economics , Hip Fractures/prevention & control , Aged , Aged, 80 and over , Cost-Benefit Analysis , Costs and Cost Analysis , Female , Hip Fractures/etiology , Humans , Italy , Osteoporosis/complications , Osteoporosis/therapyABSTRACT
AIM: Evaluation of fracture incidence in the institutionalized elderly and analysis of associated risk factors. EXPERIMENTAL DESIGN: Longitudinal and prospective study with 3-year follow-up. SETTING: Old people's home in Turin for patients who are no longer self-sufficient. PARTICIPANTS: 197 subjects (47 males and 150 females) aged between 61-98 years old, dependent in at least two basic daily activities. PARAMETERS: At the time of enrollment, the following parameters were evaluated: age, weight, height, degree of walking autonomy, bone mineral density at proximal and distal radius. The number of falls and fractures were recorded during follow-up. RESULTS: A total of 46 fractures (22 femoral and 24 in other sites) were recorded with an annual incidence of 7.8%. Femoral fractures only occurred in females. The following risk factors were associated with femoral fractures: very old age (relative risk = 2.6; 95% confidence interval = 1.1-6.4), low body mass index levels (RR = 3.3; 95% CI = 1.3-8.7), low bone mineral density levels at the proximal radius (RR = 2.6; 95% CI = 1.1-6.3), autonomous walking capacity (RR = 3.7; 95% CI = 1.1-12.0) and recurrent falls (RR = 2.7; 95% CI = 1.2-6.2). The following risk factors were associated with non-femoral fractures: autonomous deambulation (RR = 5.7; 95% CI = 1.4-23.7) and recurrent falls (RR = 6.4; CI = 2.3-18.3). CONCLUSIONS: Institutionalized elderly patients present numerous risk factors for femoral fractures. Fractures in other sites are only associated with risk factors that express a tendency to fall.
