A comparison of the effectiveness and cost of treatment for vertebral fractures in women.

Of the treatments available for the management of established vertebral osteoporosis, hormone replacement therapy (HRT), intermittent cyclical etidronate therapy and salmon calcitonin have been shown in randomized, controlled trials to reduce the risk of further vertebral fractures. In order to compare the cost effectiveness of these different treatments we examined the cost and efficacy of each treatment using previously published data. HRT, cyclical etidronate and salmon calcitonin all decrease the incidence of further vertebral fracture by 50-60%. Estimation of the cost per vertebral fracture averted therefore reflects the underlying cost of medication, with HRT costing 138-680 pounds per fracture averted compared with 1880 pound for cyclical etidronate therapy and 9075-25 013 pounds for salmon calcitonin therapy. HRT is therefore the treatment of choice for post-menopausal women with osteoporosis, particularly as it may also decrease the risk of ischaemic heart disease. Although salmon calcitonin appears as effective as the other treatments, it is considerably more expensive, so should be reserved for situations where HRT and cyclical etidronate are inappropriate.