Schousboe JT, Nyman JA, Kane RL et al: Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women. Ann Intern Med 2005; 142(9):734-41.
McClung MR: Osteopenia: To treat or not to treat? Ann Intern Med 2005;142(9):196-7 (editorial).
For postmenopausal women with osteoporosis, drug therapy reduces the rate of fractures. Whether patients with osteopenia benefit from drug therapy is less clear. The authors estimated lifetime health benefits and costs of alendronate drug therapy by a Markov model and data from population-based studies of women aged 55 to 75 years who had femoral neck T-scores between -1.5 and -2.4. The cost per quality-adjusted life-year gained ranged from $70,000 to $332,000 depending on age and bone density. They concluded that for postmenopausal Caucasian women in the United States with osteopenia and no history of clinical fractures, alendronate therapy is not cost-effective. To determine if a woman with the radiologic diagnosis of osteopenia has a clinical problem that needs pharmacologic intervention, independent risk factors for fracture such as age, previous fracture, and the tendency to fall also need to be considered.