Association of osteoporosis and varus inclination of the tibial plateau in postmenopausal women with advanced osteoarthritis of the knee

Abstract Background Although varus inclination of the tibial plateau has increasingly been recognized as a major risk factor in the progression of Osteoarthritis of the knee (OA knee), little attention has been placed on the development of the varus inclination of the tibial plateau. Osteoporosis is a disease characterized by low bone mass and may increase the risk of a stress fracture in the proximal tibia. To date, risk factors for varus inclination of the tibial plateau are rarely reported. In this study, we investigated Bone Mineral Density (BMD) as a risk factor of varus inclination of the tibial plateau in postmenopausal women with advanced OA knee. Methods A total of 90 postmenopausal women with varus OA knee who had received a total knee arthroplasty in our department between January 2016 and December 2019 were reviewed. Certain factors may correlate to inclination of the tibial plateau (Medial Tibial Plateau Angle, MTPA), including age, operation side, Kellgren-Lawrence grade of OA knee, BMD, Body Mass Index (BMI), Lateral Distal Femur Angle (LDFA), lower extremity alignment (Hip-Knee-Ankle angle, HKAA), and history of both spinal compression fracture and hip fracture were collected and analyzed. Results Osteoporosis, lower extremity varus malalignment and age were significantly associated with varus inclination of the tibial plateau (MTPA) (P = 0.15, 0.013 and 0.033 respectively). For patients with a lower extremity varus malalignment (HKAA < 175°), osteoporosis (T-score ≤ -2.5) was significantly associated with inclination of the tibial plateau. For patients with a normal lower extremity alignment (HKAA ≥ 175°), no significant association was found between osteoporosis (T-score ≤ -2.5) and varus inclination of the tibial plateau. Conclusions Osteoporosis, lower extremity varus malalignment and age are major risk factors for inclination of the tibial plateau in postmenopausal women with OA knee. More attention needs to be given to the progression of varus OA knee in postmenopausal women who simultaneously has osteoporosis and lower extremity varus malalignment.

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POS1109 MULTIVARIATE ANALYSIS OF RISK FACTORS FOR REDUCED BONE MINERAL DENSITY ASSESSED WITH RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1768 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 835.1-835

Author(s):

Z. Batalov ◽

M. Nikolov ◽

N. Nikolov

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Risk Factor ◽

Lumbar Spine ◽

Femoral Neck ◽

Body Fat ◽

Significant Risk ◽

Mineral Density ◽

X Ray ◽

T Score

Background:Radiofrequency echographic multi spectrometry (REMS) is an innovative radiation-free approach for the assessment of bone mineral density (BMD) at axial sites. The principle of this technology is based on the analysis of native raw unfiltered ultrasound signals, the so called radiofrequency ultrasound signals, acquired during an echographic scan of the lumbar spine and/or femoral neck. [1]. A previous published study showed a high degree of correlation between the T-score values provided by the two techniques-REMS and dual energy X-ray absorptiometry for both lumbar spine and femoral neck [2]. REMS software outputs information about BMD (g/cm2), T-scores, Z-scores [standard deviations (SD)], percentage of body fat and basal metabolic rate [BMR (kcal/daily)] [3].Objectives:The aim of the current study is to investigate the multivariate significant risk factors for reduced BMD through REMS technology.Methods:In this study, a total of 273 women with mean age 62 years (yrs.) ± 12 yrs. (range 25-88 yrs.) underwent REMS assessments. Subjects were divided into two groups after acquiring information about the spinal T-scores: 1st group with T-scores ≥-1 SD and 2nd group with T-scores <-1 SD. Age, weight, height, body mass index (BMI), basal metabolic rate (BMR), body fat and menopausal status were the risk factors included in the multivariate statistical analyses. Binary logistic regression was used to assess which are the significant risk factors for T-score <-1 SD. Youden’s indices were calculated for selecting the cut-off points for each risk factor.Results:273 women had mean weight of 70.5 kg. ± 15.7 kg. (range 39.4-127 kg.), mean height 157.1 cm. ± 8.8 cm. (range 100-182 cm.) and mean body mass index (BMI) 28.6 kg/cm2 ± 6.1 kg/cm2 (range 14.9-47.5 kg/cm2). The mean body fat of the subjects was 37.8% ± 8.8% (range 9-52%) and the mean BMR was 1274.01 kcal/daily ± 163.17 kcal/daily (range 929.7-1908.4 kcal/daily). 260 women (95.2%) were attributed to postmenopausal. Age (p=0.000), BMI (p=0.015), menopause (p=0.006) and BMR (p=0.000) were the multivariate significant risk factors for T-score <-1 SD. Odds ratio for the risk factor age was 1.16, so each added year of the women’s age increased the risk for T-score <-1 SD by 1.16%. Women over the age of 65 yrs. showed the highest risk for spinal T-score <-1 SD. The odds ratio of the menopause as a risk factor for spinal T-score <-1 SD was 9.54, so postmenopausal women showed about 9.5 times higher risk of T-score <-1 SD of the lumbar spine than women who still have their period. The increase of BMI by one kg/cm2 decreased the probability of spinal T-score <-1 SD by 0.15% and the increase of BMR by one kcal/daily decreased this probability by 0.02%. Women with BMI above 28.63 kg/cm2 and those with BMR >1331.75 kcal/daily were unlikely to develop spinal T-score <-1 SD.Conclusion:In the current study, multivariate regression analysis was used to develop a specific REMS-based risk prediction model for spinal BMD, corresponding to T-score <-1 SD. Postmenopausal women over age of 65 yrs. with BMI lower than 28.63 kg/cm2 and BMR <1331.75 kcal/daily were at the highest risk for T-score <-1 SD of the lumbar spine.References:[1]Pisani P, Renna MD, Conversano F, Casciaro E, Muratore M, et al. (2013) Screening and early diagnosis of osteoporosis through X-ray and ultrasound-based techniques. World J Radiol 5(11): 398-410.[2]Kirilov N. Analysis of dual-energy x-ray absorptiometry images using computer vision methods. (2020) Trakia Journal of Sciences, Vol. 18, Suppl. 1, pp 114-117.[3]Kirilova E, Kirilov N, Popov I, Vladeva S. (2019) Bone mineral density of lumbar spine and femoral neck assessed by novel echographic approach-Radiofrequency Echographic Multi Spectrometry (REMS). Clin. Cases Miner. Bone Metab., 16 (1), pp. 14-17.Disclosure of Interests:None declared.

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Treatment of Osteoporosis in Postmenopausal Women Who Are At Risk of Fracture

US Endocrinology ◽

10.17925/use.2006.00.02.1w ◽

2006 ◽

Vol 00 (02) ◽

Author(s):

Adriana Ioachimescu ◽

Angelo Licata

Keyword(s):

Risk Factors ◽

At Risk ◽

Postmenopausal Women ◽

Bone Fractures ◽

World Health ◽

Bone Mass Density ◽

Premature Menopause ◽

Mineral Density ◽

T Score ◽

Increased Risk

Osteoporosis consists of decreased bone strength and increased risk of fractures due to decreased mass and abnormal bone microarchitecure. Almost 20% of postmenopausal women have osteoporosis as defined by World Health Organization (WHO) criteria (T-score <- 2.5). Besides the bone mineral density (BMD) expressed by T-score, advancing age, premature menopause, low body weight (≤120lbs), maternal history of hip fracture, previous fracture, loss of height (≥3 inches) and the use of glucocorticosteroids are risk factors for bone fractures. Identifying the postmenopausal women at risk include both an evaluation for risk factors (including secondary causes of osteoporosis) and measurement of bone mass density (BMD) by dual X-ray absorbtiometry (DXA).

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Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled in the POSSIBLE US Treatment Cohort

International Journal of Endocrinology ◽

10.1155/2013/715025 ◽

2013 ◽

Vol 2013 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Nicole Yurgin ◽

Sally Wade ◽

Sacha Satram-Hoang ◽

David Macarios ◽

Marc Hochberg

Keyword(s):

Risk Factors ◽

Fracture Risk ◽

Postmenopausal Women ◽

Osteoporosis Treatment ◽

Mineral Density ◽

Parental History ◽

T Score ◽

History Of ◽

Loss Experience ◽

Reported Data

Subject- and physician-reported data from 4,429 postmenopausal women receiving osteoporosis treatment in the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US) were used to assess the prevalence of risk factors (RFs) and on-study fracture. RFs assessed at study entry were age >70 years; fracture since age 50; minimum T-score (hip/spine) ≤−2.5 at diagnosis; body mass index <18.5 kg/m2; rheumatoid arthritis; parental history of hip fracture; current smoking; and recent oral glucocorticoid use. Data were collected with semiannual self-administered questionnaires. Results were stratified by physician-reported osteoporosis/osteopenia diagnosis. Low T-score and age >70 years were the most common RFs in the osteoporosis group, and age >70 years and prior fracture were the most common risk factors in the osteopenia group. Multiple RFs were more common than a single RF in osteoporotic women (54.2% versus 34.6%;P<0.0001) but not osteopenic women (13.8% versus 33.6%;P<0.0001). Women with multiple RFs had more on-study osteoporosis-related fractures than women with a single RF (osteoporosis group: 9.9% versus 6.2%;P=0.0092; osteopenia group: 11.2% versus 4.7%;P<0.0001). In postmenopausal women receiving osteoporosis treatment, multiple RFs increased fracture risk. RFs, in addition to bone mineral density, can help identify candidates for osteoporosis treatment.

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POS0841 RISK FACTORS OF LOW BONE MINERAL DENSITY IN WOMEN WITH SYSTEMIC SCLEROSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1339 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 674.2-675

Author(s):

A. Efremova ◽

N. Toroptsova ◽

N. Demin ◽

O. Dobrovolskaya ◽

O. Nikitinskaya

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Systemic Sclerosis ◽

Postmenopausal Women ◽

Bone Mineral ◽

Cumulative Dose ◽

Premenopausal Women ◽

C Reactive Protein ◽

Mineral Density ◽

Reactive Protein

Background:Chronic inflammatory rheumatic diseases are risk factors of bone loss and fractures. Systemic sclerosis (SSc) has been recognized to be another potential inflammatory joint disease that may affect bone tissue.Objectives:to evaluate bone mineral density (BMD) and risk factors of low BMD in women with SSc.Methods:173 women, among them 110 postmenopausal (median age 60[55,63] years) and 63 premenopausal (median age 35[31,44] years). BMD was measured at lumbar spine (LS), femoral neck (FN) and total hip (TH) by dual energy X-ray absorptiometry (DXA, Hologic 4500A). Low BMD was diagnosed if the T-score was < -1.0 standard deviation (SD) in postmenopausal women and if the Z-score was < -2.0 SD in premenopausal women. The relationship between BMD and SSc patients’ characteristics was evaluated using univariate linear regression analysis.Results:Low BMD was found in 66% patients: 79% - in postmenopausal and 18% - in premenopausal women. Among postmenopausal persons osteoporosis was discovered in 47% and osteopenia – in 32% cases. In postmenopausal woman BMD of LS, FN and TH were associated with body mass index (BMI) (β=0.27, p=0.010; β=0.47, p<0,001 and β=0.45, p<0,001, respectively), duration of glucocorticoids (GCs) using (β=-0.31, p=0.008; β=-0.34, p=0.003 and β=-0.27, p=0.022, respectively); BMD of FN and TH with C-reactive protein (β= -0.32, p=0.016 and β= -0.29, p=0.029, respectively) and LS BMD with current and cumulative GCs dose (β= -0.24, p=0.039 and β= -0.29, p=0.014, respectively). In premenopausal women BMD of LS, FN and TH were associated with BMI (β=0.51, p<0,001; β=0.45, p=0.003 and β=0.47, p=0.002, respectively), duration of GCs using (β= -0.45, p=0.004; β= -0.47, p=0.003 and β= -0.48, p=0.002, respectively) and GCs cumulative dose (β= -0.48, p=0.002; β= -0.51, p=0.001 and β= -0.46, p=0.004, respectively); BMD of FN and TH with 25(ОН)D level (β=0.52, p=0.008 and β=0.54, p=0.005, respectively), and LS BMD with SSc duration (β= -0.44, p=0.004).Conclusion:Low BMD was diagnosed in 66% of women with SSc. Low BMI, GCs cumulative dose and duration of GCs using were independent risk factors for low BMD in both premenopausal and postmenopausal persons. Additional factors as SSc duration and low vitamin D level were found out for premenopausal and current GCs dose and C-reactive protein level for postmenopausal women.Disclosure of Interests:None declared

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Evaluation of association of fragility fracture and bone mineral density in Nepalese population

Nepal Journal of Medical Sciences ◽

10.3126/njms.v2i2.8956 ◽

2013 ◽

Vol 2 (2) ◽

pp. 130-134

Author(s):

Md. Farid Amanullah ◽

BP Shrestha ◽

GP Khanal ◽

NK Karna ◽

S Ansari ◽

...

Keyword(s):

Bone Mineral Density ◽

Risk Factor ◽

Alcohol Consumption ◽

Bone Mineral ◽

Fragility Fracture ◽

High Energy ◽

Medical Illness ◽

Mineral Density ◽

T Score ◽

Study Results

Background: Fragility fractures are one of the major health problems. Many factors are associated with it some of which are modifiable and some are not. If we know the value of T-score at which fragility fracture occurs and associated factors responsible for fragility fracture than we will be able to control this burden to the society. The objective of this study is to determine association between fragility fracture and bone mineral density (BMD) using bone densitometry and to know the value of T-score at which fragility fracture occurs. Methods: Patients presenting to B.P. Koirala Institute of Health Sciences with fragility fracture of distal end of radius, fracture around hip and vertebral fractures were included in the study to know the value of T-score at which fragility fracture occurs and their associated risk factor. Patients less than 50 years of age, high energy trauma fracture and pathological fractures were excluded from the study. Results: We found that being multipara, smoking, alcohol consumption, post-hysterectomized patients and steroid intake had significant association with fragility fracture. There was no association with religion, geographic location, associated medical illness, age, sex, associated injury and site of injury. Conclusion: The patients with risk factor for fragility fracture like smoking, alcohol consumption, multipara women, post-hysterectomized women and those who are on long term steroid therapy should undergo BMD test and the value at -3.254 are prone to fragility fracture and should be treated accordingly. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 130-134 DOI: http://dx.doi.org/10.3126/njms.v2i2.8956

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BMD status of Postmenopausal Women in relation with BMI: A study with 93 cases

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v17i2.28200 ◽

2016 ◽

Vol 17 (2) ◽

pp. 138-141

Author(s):

Samira Sharmin ◽

Mabubul Haque ◽

Syedur Rahman Miah ◽

Md Mahbub Ur Rahman ◽

Jasmine Ara Haque ◽

...

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Lumbar Vertebrae ◽

The Body ◽

Mineral Density ◽

Cross Sectional ◽

T Score ◽

Minimal Trauma ◽

The Mean

Objectives: Low bone mass is a common disorder in elderly population which predisposes to fracture with minimal trauma. This study was performed to find out the association between the Body Mass Index (BMI) and Bone Mineral Density (BMD) in postmenopausal women.Materials and Methods: This cross sectional study was carried out at Institute of Nuclear Medicine and Allied Sciences Comilla and Mitford, Dhaka over a period of 12 months from January 2013 to December 2013. A total 93 postmenopausal women were enrolled for this study. All postmenopausal women underwent a BMD scan of femoral neck and lumbar vertebrae using a Dual Energy X-ray Absorptiometry (DEXA). Participants were categorized into three groups according to their age and BMI. BMD were expressed base on T-score according to WHO criteria. The relation among BMI, age and BMD were assessed.Results: The results of this study showed that the mean age of the study group was 57.13±7.49 years with range of 46 to 75 years. The most postmenopausal women were in age group 55-65years. The mean BMI of the study subjects were 24.18±5.08 kg/m2 with a range of 15.62 to 36.20 kg/m2. Among 93 subjects osteopenia was greater at lumbar spine (45.2%) with T-score mean±SD-1.83±0.33 and osteoporosis at femoral neck (51.6%) with T-score mean ±SD-3.36±-0.67. Pearsons correlation coefficient test showed inverse relationship between age and BMD both lumbar spine (r = -0.301, p = 0.003) and femoral neck (r = -0.303, p=0.003) whereas the positive relation between BMI and BMD both at lumbar spine (r=0.338, p=0.001) and femoral neck (r =0.343, p=0.001). These showed that with advancing age, BMD decreases and the risk of osteoporosis increases and with increasing BMI, BMD increases and risk of osteoporosis decreases.Conclusion: The findings of this study portrait that aging and low BMI are risk factors associated with bone loss. So preventive measure should be taken for high risk post menopausal women.Bangladesh J. Nuclear Med. 17(2): 138-141, July 2014

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Risk factors for decreased bone mineral density in men with type 2 diabetes.

Diabetes Mellitus ◽

10.14341/dm12383 ◽

2021 ◽

Vol 23 (5) ◽

pp. 424-433

Author(s):

Olga N. Fazullina ◽

Anton I. Korbut ◽

Maksim V. Dashkin ◽

Vadim V. Klimontov

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Lumbar Spine ◽

Femoral Neck ◽

Fat Mass ◽

Free Testosterone ◽

Mineral Density ◽

T Score ◽

25 Oh Vitamin D

BACKGROUND: Type 2 diabetes and osteoporosis are widespread diseases in the middle-aged and elderly people. Most studies of osteoporosis in patients with type 2 diabetes have been performed in women; meantime risk factors for lowering bone mineral density (BMD) in men have been little studied.AIMS: to identify risk factors for decreased BMD at the lumbar spine, femoral neck and forearm in men with type 2 diabetes.METHODS: Eighty two men from 50 to 75 years old, with duration of diabetes for at least one year, were included in the study. Individuals with known risk factors for secondary osteoporosis were not included. Twenty-three men with normal BMD having no diabetes or obesity were acted as control. The T-score at the lumbar spine, femoral neck and forearm of a non-dominant arm, as well as body composition parameters, were evaluated by dual-energy X-ray absorptiometry. The levels of hormones that affect bone metabolism (parathyroid hormone, free testosterone, 25-OH vitamin D) were measured in blood serum by ELISA. Risk factors for reducing BMD were identified using multivariate regression analysis and receiver operating characteristic (ROC) curves.RESULTS: Among patients with diabetes, 49 individuals had normal BMD and 33 showed decreased T-score values (<-1 SD). Free testosterone <5.92 pg/ml was predictor for decreased BMD at the lumbar spine (OR=4.4, p=0.04). For femoral neck, the risk factors were body weight <95.5 kg (OR=2.8, p=0.04), total fat mass <27 kg (OR=3.3, p=0.03), truncal fat mass<17.5 kg(OR=4.5, p=0.006), android (central abdominal) fat mass <3.2 kg(OR=4.0, p=0.01), gynoid (hip) fat mass <3.5 kg(OR=3.3, p=0.02), and lean mass <59 kg(OR=3.0, p=0.04). Risk factors for reduced BMD at the forearm were diabetes duration>15.5 years (OR=3.7, p=0.03) and HbA1c <8.15% (OR=3.8, p=0.03). Parathyroid hormone and 25-OH-vitamin D did not predict BMD independently.CONCLUSIONS: In men with type 2 diabetes, low free testosterone is a risk factor for decreased BMD in the lumbar spine, and diabetes duration is a risk factor for decreased BMD in the forearm. The presence of obesity is associated with an increase in BMD in the femoral neck; a high HbA1c is associated with an increase in BMD in the forearm.

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Relation between intima-media thickness and bone mineral density in postmenopausal women: a cross-sectional study

Sao Paulo Medical Journal ◽

10.1590/s1516-31802011000300004 ◽

2011 ◽

Vol 129 (3) ◽

pp. 139-145 ◽

Cited By ~ 9

Author(s):

Daniela Fodor ◽

Cosmina Bondor ◽

Adriana Albu ◽

Laura Muntean ◽

Siao-pin Simon ◽

...

Keyword(s):

Lumbar Spine ◽

Femoral Neck ◽

Postmenopausal Women ◽

Atherosclerotic Plaque ◽

Vertebral Fractures ◽

Mineral Density ◽

Cross Sectional ◽

T Score ◽

Osteoporotic Vertebral Fractures ◽

The Relationship

CONTEXT AND OBJECTIVES: Controversy exists regarding the relationship between atherosclerosis and osteoporosis. The aim of this study was to determine the relationship between intima-media thickness (IMT) of the common carotid artery (CCA), presence of calcified atherosclerotic plaques and bone mineral density (BMD) evaluated by dual energy X-ray absorptiometry (DXA), in postmenopausal women. DESIGN AND SETTING: Cross-sectional study at Second Internal Medicine Clinic, Cluj-Napoca, Romania. METHODS: We studied the IMT (left and right CCA and mean IMT) and T-score (lumbar spine L2-L4, femoral neck and total hip) in 100 postmenopausal women (mean age 64.5 years). The presence of calcified atherosclerotic plaque and osteoporotic vertebral fractures was also noted. RESULTS: IMT in the left and right CCA and mean IMT were significantly associated with T-score measured for the lumbar spine L2-L4, femoral neck and total hip, with lower T-score, in the osteoporotic group than in the normal and osteopenic groups (P < 0.05). IMT had a significantly negative correlation with the lumbar spine T-score and femoral neck T-score; and mean IMT with lowest T-score. Mean IMT (P < 0.001), high blood pressure (P = 0.005) and osteoporotic vertebral fractures (P = 0.048) showed statistical significance regarding the likelihood of developing atherosclerotic plaque. CONCLUSIONS: In women referred for routine osteoporosis screening, the relationship between CCA, atherosclerosis and osteoporosis can be demonstrated using either cortical or trabecular BMD. Vertebral fractures may be considered to be a likelihood factor for atherosclerotic plaque development.

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Can Melatonin Improve the Osteopenia of Perimenopausal and Postmenopausal Women? A Meta-Analysis

International Journal of Endocrinology ◽

10.1155/2019/5151678 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Tingting Bao ◽

Liuting Zeng ◽

Kailin Yang ◽

Yuehua Li ◽

Fengying Ren ◽

...

Keyword(s):

Postmenopausal Women ◽

Meta Analysis ◽

Analysis Data ◽

Nutritional Supplement ◽

Current Evidence ◽

Control Group ◽

Mineral Density ◽

T Score ◽

Registration Number ◽

Substantial Heterogeneity

Objective. To assess the effectiveness and safety of melatonin for perimenopausal and postmenopausal women with osteopenia. Methods. In this meta-analysis, data from randomized controlled trials were obtained to assess the effects of melatonin versus placebo or western medicine in perimenopausal and postmenopausal women with osteopenia. The study’s registration number is CRD42018086238. The primary outcomes included bone mineral density (BMD) and T-score. Result. From 551 articles retrieved, three trials involving 121 patients were included. Due to the high-to-substantial heterogeneity (BMD: I2=96.9%, P=0.000; T-score: I2=74.9%, and P=0.019), the statistical analysis of BMD and T-score was abandoned. A systematic review was undergone for the two outcomes. Compared with the control group, melatonin may increase osteocalcin (WMD 4.97; 95% CI 3.14, 6.79; P<0.00001). Conclusion. Based on current evidence, melatonin might be used as a safe nutritional supplement to improve bone density in perimenopausal and postmenopausal women, but its efficacy needs to be further affirmed.

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Cost-effectiveness of zoledronic acid (ZOL) in postmenopausal women with early breast cancer receiving adjuvant letrozole.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.553 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 553-553

Author(s):

Mei Xue ◽

Peter Fishman ◽

Marc Botteman

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Postmenopausal Women ◽

Early Breast Cancer ◽

Disease Free Survival ◽

Mineral Density ◽

Free Survival ◽

T Score ◽

Life Years ◽

Disease Free

553 Background: In the ZO-FAST trial, postmenopausal women with early breast cancer and a bone mineral density (BMD) T-score ≥ –2 and receiving adjuvant letrozole (2.5 mg/day) were randomized to either immediate ZOL (4 mg/6 months) treatment (upfront ZOL) or to the same therapy but only when BMD T-score decreased to < –2 or fracture occurrence (delayed ZOL). After 60 months, upfront ZOL increased both BMD and disease-free survival (P < .05) relative to delayed ZOL. The present analysis assessed, from a US payer perspective, the cost effectiveness of upfront ZOL vs delayed ZOL in this population. Methods: A Markov state-transition model was developed to estimate the lifetime costs and quality-adjusted life-years (QALYs) for a hypothetical cohort of postmenopausal women with early breast cancer receiving letrozole with upfront or delayed ZOL. Consistent with ZO-FAST, patients were 57 years of age and breast cancer recurrence-free at baseline. Patients could progress over time to Local Recurrence, Contra-lateral Tumor, Distant Recurrence, or Death. Transition probabilities were derived from ZO-FAST, supplemented with literature. Costs and utilities were literature based. All outcomes were discounted 3% per year. Results: Compared to delayed ZOL, upfront ZOL resulted in better overall survival, disease-free survival, and QALYs, but at a higher cost (Table). In the base case, the incremental cost/QALY gained with upfront vs delayed ZOL was $7,967. In > 95% of 1,000 probabilistic sensitivity analysis runs, upfront ZOL costs less than $38,376/QALY gained. Conclusions: Upfront ZOL may increase survival and QALY and, at a cost per QALY well under the $50,000/QALY threshold, is very cost-effective in this population. [Table: see text]

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