Osteoporosis affects 10 million people in the U.S., and the associated morbidity, mortality, and costs are significant. Screening and treatment of individuals at increased risk of osteoporotic fracture can substantially reduce fracture risk and improve health outcomes. There are multiple osteoporosis screening tests available, including dual-energy x-ray absorptiometry (DXA), risk assessment instruments, calcaneal quantitative ultrasound (QUS), and quantitative computed tomography (QCT). However, there is lack of an evidence-based consensus regarding the most effective and cost-effective population screening strategies for older women and men, specifically which tests or sequence of tests, screening initiation ages, and repeat screening intervals are best. The United States Preventive Services Task Force has identified that further research is of paramount importance to define the appropriate use of various osteoporosis screening modalities and optimal screening intervals. The goal of this proposed research is to identify best osteoporosis population screening strategies for older U.S. women and men that can be implemented to improve osteoporosis-related health outcomes. To achieve this goal, we will first systematically review the performance characteristics of risk assessment tools and QCT, whose performance characteristics are not currently well defined (Aim 1). We will then use this information, along with published data on performance of other osteoporosis screening tests (DXA and QUS), osteoporosis-related costs, and osteoporosis-related outcomes to construct comprehensive microsimulation cost-effectiveness models to compare multiple screening tests, initiation ages, and intervals for both women aged 50 and older and men aged 60 and older (Aims 2 and 3). No prior study has compared the large range of screening options we plan to compare. Our findings will include specific recommendations for clinicians and policymakers regarding osteoporosis screening strategies that can be implemented to improve health outcomes in older adults.

Public Health Relevance

Osteoporosis affects 10 million Americans, and is associated with substantial morbidity, mortality, and costs. The goal of this proposed research is to identify the most effective and cost-effective osteoporosis population screening strategies for older U.S. women and men that can be implemented to improve health outcomes.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR060809-04
Application #
8449118
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Chen, Faye H
Project Start
2011-04-01
Project End
2014-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
4
Fiscal Year
2013
Total Cost
$240,148
Indirect Cost
$90,523
Name
Swedish Medical Center, First Hill
Department
Type
DUNS #
079264420
City
Seattle
State
WA
Country
United States
Zip Code
98122
Nayak, S; Edwards, D L; Saleh, A A et al. (2014) Performance of risk assessment instruments for predicting osteoporotic fracture risk: a systematic review. Osteoporos Int 25:23-49
Nayak, Smita; Roberts, Mark S; Greenspan, Susan L (2012) Impact of generic alendronate cost on the cost-effectiveness of osteoporosis screening and treatment. PLoS One 7:e32879
Nayak, Smita; Roberts, Mark S; Greenspan, Susan L (2011) Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women. Ann Intern Med 155:751-61