Table 1.
Input Parameters
| Parameter | Base case | Range for sensitivity analyses | Distribution | References | ||||
|---|---|---|---|---|---|---|---|---|
| BMD related-risk of fractures (hip, clinical vertebral, and wrist) | Calculated using data from references | – | 2, 10, 14 | |||||
| Ten-year absolute risk of fractures and categorization (low-, moderate-, high-risk) | Calculated using data from references | – | 17, 18 | |||||
| BMD distribution | Estimated from a representative cohort of 2104 women aged 40 years and older | – | 18 | |||||
| Osteoporosis investigation after fracture | 0.21 | 0.017–0.50 | Uniform | 19 | ||||
| Osteoporosis treatment/prevention after fracture | 0.756 if osteoporosis; 0.294 if low BMD; 0.09 if normal BMD | – | 19 | |||||
| Compliance rate to osteoporosis treatments | 0.49 | 30–75 | Uniform | 20 | ||||
| RR death following hip and clinical vertebral fracture | 4.31 (hip); 2.85 (vertebral); Probability of death = RRX probability of age-specific death probability in Quebec | – | 15, 21 | |||||
| Acute rehabilitation for hip fracture | 0.48 | – | 22 | |||||
| Long care (hip fracture) | 0.20 | 0.10–0.282 | Uniform | 22–24 | ||||
| Wrist fracture surgery | 0.18 | – | 25 | |||||
| Clinical vertebral fracture hospitalization | 0.10 | – | 22 | |||||
| RR fracture | ||||||||
| Risedronate | Hip: 0.72; Clinical vertebral: 0.58; Wrist: 0.82 | Hip: 0.58–0.88; Clinical vertebral: 0.50–0.67; Wrist: 0.74–0.90 | Log normal | 26 | ||||
| Vitamin D and calcium | 0.88 | 0.83–0.95 | Log normal | 6 | ||||
| Physical activity (hip only) | 0.62 | 0.54–0.69 | Log normal | 27 | ||||
| Sensitivity/specificity | Sensitivity/specificity | Distribution | References | |||||
| Performance of questionnaire | ||||||||
| OST | 0.768/0.514 | 0.70–0.95/0.30–0.70 | Uniform | 28 | ||||
| SCORE | 0.90/0.32 | 0.80–100/0.20–0.50 | Uniform | 29 | ||||
| ORAI | 0.933/0.464 | 0.85–100/0.30–0.80 | Uniform | 30 | ||||
| Participation rate to interventions | 0.531 | 0.30–0.70 | Uniform | 31 | ||||
| Utilities | Score calculated | Sensitivity analyses range | Distribution | References | ||||
| Hip fracture | ||||||||
| Hospitalization postfracture | 0.30 | 0.51–0.60 | Uniform | 32 | ||||
| Rehabilitation | 0.56 | 0.63–0.70 | Uniform | 32 | ||||
| Postrehabilitation | 0.85 | 0.73–0.90 | Uniform | 32 | ||||
| Clinical vertebral fracture | ||||||||
| Hospitalization | 0.33 | – | ||||||
| Rehabilitation | 0.68 | – | ||||||
| Postrehabilitation | 0.85 | 0.76–0.90 | Uniform | 33, 34 | ||||
| Wrist fracture | ||||||||
| Emergency room | 0.61 | – | ||||||
| Rehabilitation | 0.88 | – | ||||||
| Postrehabilitation | 1.00 | 0.82–1.00 | Uniform | 33 | ||||
| Item | Probability | Frequency | Cost ($CAD)/person | Distribution | References | |||
| Hip fracture | ||||||||
| Acute care (emergency and surgery) | 1.00 | 1 | 4,070 | – | 22, 24, 35–37 | |||
| Hospitalization | 1.00 | 14 days | 19,760 15,808–23,712 | Uniform | 38 | |||
| Inpatient medical visits | 1.00 | 14 | 229 | – | 35 | |||
| Acute rehabilitation | 0.48 | 30 days | 24,639 | – | 22, 24, 35, 36 | |||
| Long-term care | 0.20 | 1 year | 74,646 | – | 22, 24, 39 | |||
| Follow-up | 0.80 | 3 medical visits, 3 control X-rays, 7 physiotherapy sessions | 990 | – | 22, 35–37 | |||
| Clinical vertebral fracture | ||||||||
| Acute care (emergency visit) | 1.00 | 1 | 1004 | – | 22, 35, 36 | |||
| Hospitalization | 0.1 | 9 days | 8047 (6261–9891) | Uniform | 22 | |||
| Inpatient medical visits | 1.00 | 9 | 146 | – | 22, 35 | |||
| Follow up | 1.00 | 2 control X-rays, 2 control medical visits, 7 physiotherapy sessions | 550 | – | 22, 35, 36 | |||
| Wrist fracture | ||||||||
| Acute care + conservative treatment | 0.82 | 1 | 1250 | – | 22, 25, 35, 36 | |||
| Acute care + surgery | 0.18 | 1 | 3839 | – | 22, 25, 35, 36 | |||
| Follow-up | 1.0 | 2 control X-rays, 2 control medical visits, 7 physiotherapy sessions | 467 | – | 22, 35, 36 | |||
| Osteoporosis screening | ||||||||
| Medical visit and exams | – | 1 | 160 | – | – | |||
| DXA | – | 1 | 107.5 | – | 1, 4, 35, 36, 40 | |||
| Osteoporosis treatment | ||||||||
| Vitamin D and calcium | – | Annual | 160 | – | 4, 41 | |||
| Physical activity | – | Annual | 5 | – | 4, 42 | |||
| Biphosphonate (risedronate) | – | Annual | 162.25 | – | 4, 41 | |||
| Follow-up | ||||||||
| Follow-up medical visit | – | Annual | 99.53 | – | 1, 35, 36, 43 | |||
| Control DXA | – | 2 years or 5 years (if low risk of fracture) | 98.5 | – | 4, 35, 36 | |||
| Discount rate | 3% (0 and 5) | – | ||||||
BMD = bone mineral density; RR = relative risk; RRX = probability of death; OST = Osteoporosis Self-Assessment Tool; SCORE = Simple Calculated Osteoporosis Risk Estimation; ORAI = Osteoporosis Risk Assessment Instrument; $CAD = Canadian dollars; DXA = dual-energy X-ray absorptiometry.