Table 1.

Parameter Estimates^a

Parameter	Base Value	Probability Distribution	Reference
Natural history data
Relative risk of wrist fracture for each 1 SD decrease in bone density	1.4	Lognormal (1.4, 1.6)	7
Relative increase of hip fracture for 1 each SD decrease in bone density	2.6	Lognormal (2, 3.5)	7
Relative increase of vertebral fracture for each 1 SD decrease in bone density	1.8	Lognormal (1.1, 2.7)	7
Relative risk of hip fracture given previous fracture	2	Lognormal (1.9, 2.2)	30
Relative risk of wrist fracture given previous fracture	1.9	Lognormal (1.3, 2.8)	30
Relative risk of spine fracture given previous fracture	2	Lognormal (1.6, 2.4)	30
Relative risk of hip fracture given living in LTC	1.5	Lognormal (1.3, 1.7)	31
Relative risk of mortality post hip fracture and living in LTC	3.24	Lognormal (2.37, 4.43)	34
Relative risk of mortality post vertebral fracture	1.16	Lognormal (1.03, 1.3)	35
Relative risk of mortality post hip fracture	2.87	Lognormal (2.52, 3.27)	5
Relative risk of mortality given living in LTC	1.16	Lognormal (1.1, 1.2)	17
Average peak bone mass	0.857	Normal (0.857, 0.022)	3
Bone mass by age
50–59	0.759	Normal (0.759, 0.003)	3
60–69	0.695	Normal (0.695, 0.003)	3
70–79	0.661	Normal (0.661, 0.003)	3
80+	0.593	Normal (0.593, 0.006)	3
Standard deviation for peak bone mass	0.125		3
Standard deviation of bone mass by age
50–59	0.119		3
60–69	0.110		3
70–79	0.114		3
80+	0.104		3
Annual probability of vertebral fracture
50–59	0.0018	Beta (8.05, 4559.45)	6
60–69	0.0015	Beta (4.01, 2626.34)	6
70–79	0.0039	Beta (74.44, 18813.8)	6
80+	0.0076	Beta (137.16, 17832.5)	6
Annual probability of wrist fracture
50–59	0.0031	Beta (14.08, 4550.05)	6
60–69	0.0062	Beta (16.18, 2613.58)	6
70–79	0.0086	Beta (309, 35802.22)	6
80+	0.0076	Beta (137.16, 17832.5)	6
Annual probability of hip fracture
50–59	0.0003	Beta (2.12, 7215.24)	6
60–69	0.0018	Beta (4.84, 2623.84)	6
70–79	0.0024	Beta (45.71, 18834)	6
80+	0.0064	Beta (115.92, 17861.69)	6
Proportion of women residing in LTC
65–69	0.01	Beta (8,952, 886,248)	32
70–74	0.023	Beta (15,235, 647,165)	32
75–79	0.057	Beta (29,372, 485,928)	32
80–84	0.136	Beta (57,120, 362,880)	32
>85	0.334	Beta (156,446, 311,954)	32
Proportion of women who are osteoporotic
50–59	0.060	Beta (1,196, 1,273)	3
60–69	0.183	Beta (1,505, 1,841)	3
70–79	0.269	Beta (991, 1,356)	3
>80	0.413	Beta (184, 313)	3
Mortality in general population (females)
50–54	0.0024	Beta (1,368,800, 1,372,100)	33
55–59	0.0036	Beta (1,248,734, 1,253,300)	33
60–64	0.0057	Beta (1,061,242, 1,067,300)	33
65–69	0.0091	Beta (887,055, 895,200)	33
70–74	0.0150	Beta (652,462, 662,400)	33
75–79	0.0254	Beta (502,196, 515,300)	33
80–84	0.0443	Beta (401,409, 420,000)	33
85–89	0.0789	Beta (265,173, 287,900)	33
>90	0.1772	Beta (148,523, 180,500)	33
Proportion of vertebral fractures by treatment requirement
Hospitalized	0.09	Dirichlet (18, 47, 132)	6
Physician care	0.24		6
No treatment	0.67		6
Proportion of wrist fractures requiring hospitalization	0.10	Beta (3,697, 33,341)	4
Treatment effectiveness
Relative reduction in hip fractures
Alendronate	0.59	Lognormal (0.29, 0.99)	26
Etidronate	1.02	Lognormal (0.12, 3.71)	26
Risedronate	0.78	Lognormal (0.44, 1.31)	26
Denosumab	0.67	Lognormal (0.24, 1.46)	26
Zoledronate	0.65	Lognormal (0.25, 1.33)	26
Relative reduction in wrist fractures
Alendronate	0.93	Lognormal (0.31, 2.51)	26
Etidronate	2.32	Lognormal (0.26, 8.13)	26
Risedronate	0.91	Lognormal (0.13, 3.06)	26
Denosumab	0.84	Lognormal (0.64, 1.11)	26
Relative reduction in vertebral fractures
Alendronate	0.54	Lognormal (0.4, 0.7)	26
Etidronate	0.64	Lognormal (0.31, 1.07)	26
Risedronate	0.66	Lognormal (0.48, 0.81)	26
Denosumab	0.33	Lognormal (0.23, 0.47)	26
Zoledronate	0.30	Lognormal (0.21, 0.43)	26
Treatment continuation rates
Alendronate (daily)	0.65	Beta (65, 35)	14
Etidronate	0.57	Beta (57, 43)	14
Risedronate (daily)	0.62	Beta (62, 38)	14
Relative reduction in noncompliance
Once weekly bisphosphonates versus once daily	0.719	Lognormal (0.7126, 0.7265)	27
Denosumab versus bisphosphonates	0.540	Lognormal (0.31, 0.93)	28
Zoledronate versus denosumab	1.256	Lognormal (1.15, 1.37)	29
Cost of health care events
Hip fracture—living in the community	50513.75	Gamma (50,514, 401)	18,19
Hip fracture—living in LTC	19582.77	Gamma (19,583, 403)	18,19
Hip fracture—women who die following fracture	12207.83	Gamma (12,208, 1429)	18,19
2nd year post hip fracture	5134.32	Gamma (5,134, 210)	18,19
Wrist fracture—ambulatory	411.40	Gamma (411, 4)	21
Wrist fracture—hospitalized	8557.40	Gamma (8,557, 435)	20
Vertebral fracture—ambulatory	612.40	Gamma (612, 10)	21
Vertebral fracture—hospitalized	12613.40	Gamma (12,613, 559)	20
No fracture—living in LTC	46301.57	Gamma (46,302, 953)	18,19
No fracture—living in community	9086.38	Gamma (9,086, 72)	18,19
Annual drug costs
Alendronate	153.66	Fixed	22
Etidronate	122.88	Fixed	22
Risedronate	180.31	Fixed	22
Denosumab	825.67	Fixed	22
Zoledronate	371.06	Fixed	22
Utility values
Women aged 65–69—no fracture	0.836	1 − Lognormal (0.164, 0.004)	23
Women aged 70–74—no fracture	0.824	1 − Lognormal (0.176, 0.004)	23
Women aged 75–79—no fracture	0.792	1 − Lognormal (0.208, 0.005)	23
Women aged >80—no fracture	0.712	1 − Lognormal (0.288, 0.005)	23
Hip fracture—1st year—utility multiplier	0.7	1 − Lognormal (0.3, 0.033)	24
Hip fracture—2nd year—utility multiplier	0.8	1 − Lognormal (0.2, 0.071)	24
Vertebral fracture—hospitalized—utility multiplier	0.59	1 − Lognormal (0.41, 0.094)	24
Wrist—utility multiplier	0.956	1 − Lognormal (0.044, 0.036)	24
Vertebral fracture—not hospitalized—utility multiplier	0.909	1 − Lognormal (0.091, 0.043)	25

LTC, long-term care; SD, standard deviation.

^aBeta and gamma distributions depicted by shape and scale parameters. Dirichlet distribution depicted by concentration parameters. Normal distributions depicted by mean and standard errors. Lognormal distribution depicted by upper and lower bounds of the 95% confidence interval. Costs represent CAN$ in 2017.