Treatment of established osteoporosis: a systematic review and cost-utility analysis.

Authors' conclusions Cost-effective scenarios for several interventions in the management of established osteoporosis were identified. Costeffectiveness ratios decrease with age. At age 50 years, only HRT and calcium plus vitamin D were cost-effective (assuming that the agent would decrease the risk of appendicular fractures at this age). At age 80 years, HRT, calcium with or without vitamin D, alfacalcidol, alendronate and bisphosphonate were all cost-effective.

[1]  H K Genant,et al.  Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. , 1999, Archives of internal medicine.

[2]  N. Weiss,et al.  Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. , 1980, The New England journal of medicine.

[3]  H. Orimo,et al.  [Involutional osteoporosis]. , 1991, Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics.

[4]  J. Windeler,et al.  Events per person year—a dubious concept , 1995, BMJ.

[5]  H K Genant,et al.  Defining Incident Vertebral Deformity: A Prospective Comparison of Several Approaches , 1999, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[6]  S. Cummings,et al.  Hormone therapy to prevent disease and prolong life in postmenopausal women , 1992, Annals of internal medicine.

[7]  M. Vessey,et al.  Hormone Replacement Therapy in the Menopause: Risks, Benefits and Costs , 1990 .

[8]  E. Pauwels,et al.  Skeletal metabolism in patients with osteoporosis after discontinuation of long-term treatment with oral pamidronate. , 1995, The Journal of clinical endocrinology and metabolism.

[9]  S. Cummings,et al.  The Effect of Raloxifene on Risk of Breast Cancer in Postmenopausal Women: Results From the MORE Randomized Trial , 2000 .

[10]  Four-year study of intermittent cyclic etidronate treatment of postmenopausal osteoporosis: three years of blinded therapy followed by one year of open therapy. , 1994, The American journal of medicine.

[11]  A. Cöster,et al.  Therapy of Established Postmenopausal Osteoporosis with Monofluorophosphate plus Calcium: Dose-Related Effects on Bone Density and Fracture Rate , 1999, Osteoporosis International.

[12]  Claus Christiansen,et al.  Diagnosis of Osteoporosis , 1992, Southern medical journal.

[13]  S. Cummings,et al.  Effect of alendronate on limited-activity days and bed-disability days caused by back pain in postmenopausal women with existing vertebral fractures. Fracture Intervention Trial Research Group. , 2000, Archives of internal medicine.

[14]  M. Drummond,et al.  Selection of End Points in Economic Evaluations of Coronary-heart-disease Interventions , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[15]  J. Ringe,et al.  Treatment of Glucocorticoid-Induced Osteoporosis with Alfacalcidol/Calcium Versus Vitamin D/Calcium , 1999, Calcified Tissue International.

[16]  C. Cooper,et al.  Use of cyclical etidronate and prevention of non-vertebral fractures. , 1998, British journal of rheumatology.

[17]  K. Newton,et al.  Risk of hospital admission for idiopathic venous thromboembolism among users of postmenopausal oestrogens , 1996, The Lancet.

[18]  H. Genant,et al.  Alendronate treatment of the postmenopausal osteoporotic woman: effect of multiple dosages on bone mass and bone remodeling. , 1995, The American journal of medicine.

[19]  B. Sherwin.  Hormones, mood, and cognitive functioning in postmenopausal women. , 1996, Obstetrics and gynecology.

[20]  J R Beck,et al.  Markov Models in Medical Decision Making , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[21]  Compliance with hormone replacement therapy (HRT) after screening for post menopausal osteoporosis , 1992, British journal of obstetrics and gynaecology.

[22]  C. Christiansen,et al.  Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. , 1997, The New England journal of medicine.

[23]  D. Reid,et al.  The economics of osteoporosis and its prevention. A review. , 1997, PharmacoEconomics.

[24]  R. Lindsay,et al.  Addition of alendronate to ongoing hormone replacement therapy in the treatment of osteoporosis: a randomized, controlled clinical trial. , 1999, The Journal of clinical endocrinology and metabolism.

[25]  P. Geusens,et al.  Oral alendronate induces progressive increases in bone mass of the spine, hip, and total body over 3 years in postmenopausal women with osteoporosis. , 1996, Bone.

[26]  R. Francis,et al.  A comparison of the effectiveness and cost of treatment for vertebral fractures in women. , 1995, British journal of rheumatology.

[27]  J A Kanis,et al.  Epidemiology of vertebral osteoporosis. , 1992, Bone.

[28]  O Johnell,et al.  Risk of hip fracture according to the World Health Organization criteria for osteopenia and osteoporosis. , 2000, Bone.

[29]  M. Hooper,et al.  Randomized Trial of the Effects of Risedronate on Vertebral Fractures in Women with Established Postmenopausal Osteoporosis , 2000, Osteoporosis International.

[30]  J. Kanis,et al.  Cost-effectiveness of preventing hip fractures in the elderly population using vitamin D and calcium. , 1995, QJM : monthly journal of the Association of Physicians.

[31]  D. Quinton,et al.  Unit Costs of Health and Social Care 2004 , 2004 .

[32]  W M O'Fallon,et al.  Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. , 1990, The New England journal of medicine.

[33]  P. Meunier,et al.  EVIDENCE‐BASED MEDICINE AND OSTEOPOROSIS: A COMPARISON OF FRACTURE RISK REDUCTION DATA FROM OSTEOPOROSIS RANDOMISED CLINICAL TRIALS , 1999, International journal of clinical practice.

[34]  B. O'brien,et al.  A critical structured review of economic evaluations of interventions for the prevention and treatment of osteoporosis , 1999 .

[35]  J. Reginster,et al.  Fluoride Salts are no Better at Preventing New Vertebral Fractures than Calcium-Vitamin D in Postmenopausal Osteoporosis: The FAVOStudy , 1998, Osteoporosis International.

[36]  H. Ma,et al.  Menopausal osteoporosis , 1994, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[37]  L. Rovati,et al.  Avoidance of Vertebral Fractures in Men with Idiopathic Osteoporosis by a Three Year Therapy with Calcium and Low-Dose Intermittent Monofluorophosphate , 1998, Osteoporosis International.

[38]  Jesse A Berlin,et al.  Does blinding of readers affect the results of meta-analyses? , 1997, The Lancet.

[39]  O. Johnell,et al.  Long-Term Risk of Osteoporotic Fracture in Malmö , 2000, Osteoporosis International.

[40]  H. Rico,et al.  Total and regional bone mineral content and fracture rate in postmenopausal osteoporosis treated with salmon calcitonin: A prospective study , 1995, Calcified Tissue International.

[41]  J. Reginster,et al.  The Effect of Sodium Monofluorophosphate plus Calcium on Vertebral Fracture Rate in Postmenopausal Women with Moderate Osteoporosis , 1998, Annals of Internal Medicine.

[42]  J. Carson,et al.  Risk of venous thromboembolism in users of hormone replacement therapy , 1996, The Lancet.

[43]  J. Birkenhäger,et al.  Can nandrolone add to the effect of hormonal replacement therapy in postmenopausal osteoporosis? , 1992, Bone and mineral.

[44]  C. Cooper,et al.  Risk of hip fracture in women with vertebral fracture , 1994, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[45]  D. Torgerson,et al.  Osteoporosis prevention through screening: will it be cost effective? , 1993, Bailliere's clinical rheumatology.

[46]  G. Mclauchlan,et al.  Epidemiology of fractures in 15 000 adults: The influence of age and gender , 1998 .

[47]  K. McPherson,et al.  Impact of postmenopausal hormone therapy on cardiovascular events and cancer: pooled data from clinical trials , 1997, BMJ.

[48]  Hormone replacement therapy and risk of venous thromboembolism: population based case-control study. , 1997, BMJ.

[49]  D. Shoback,et al.  Clinical Effects of Raloxifene Hydrochloride in Women , 1999, Annals of Internal Medicine.

[50]  R. Rizzoli,et al.  Protein Supplements Increase Serum Insulin-Like Growth Factor-I Levels and Attenuate Proximal Femur Bone Loss in Patients with Recent Hip Fracture , 1998, Annals of Internal Medicine.

[51]  J. Townsend,et al.  Hormone replacement therapy: assessment of present use, costs, and trends. , 1998, The British journal of general practice : the journal of the Royal College of General Practitioners.

[52]  P Kannus,et al.  Prevention of hip fracture in elderly people with use of a hip protector. , 2000, The New England journal of medicine.

[53]  M. Weinstein,et al.  Cost effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy. , 1990, Annals of internal medicine.

[54]  D. Kiel,et al.  The effect of postmenopausal estrogen therapy on bone density in elderly women. , 1993, The New England journal of medicine.

[55]  D. Kimmel,et al.  Dose-Response Relationships for Alendronate Treatment in Osteoporotic Elderly Women , 1997 .

[56]  Toshitaka Nakamura,et al.  Reduced occurrence of vertebral crush fractures in senile osteoporosis treated with 1 alpha (OH)-vitamin D3. , 1987, Bone and mineral.

[57]  B. Kopjar,et al.  Survival after Hip Fracture: Short- and Long-Term Excess Mortality According to Age and Gender , 1999, Osteoporosis International.

[58]  J. Zerwekh,et al.  Safe and effective treatment of osteoporosis with intermittent slow release sodium fluoride: augmentation of vertebral bone mass and inhibition of fractures. , 1989, The Journal of clinical endocrinology and metabolism.

[59]  E. Barrett-Connor,et al.  Hormone replacement therapy, heart disease, and other considerations. , 1998, Annual review of public health.

[60]  D. Torgerson,et al.  Using Economics to Prioritize Research: A Case Study of Randomized Trials for the Prevention of Hip Fractures Due to Osteoporosis , 1996, Journal of health services research & policy.

[61]  O. Johnell,et al.  Bone Mineral Density Is a Predictor of Survival , 1998, Calcified Tissue International.

[62]  S. Ebrahim,et al.  Randomized placebo-controlled trial of brisk walking in the prevention of postmenopausal osteoporosis. , 1997, Age and ageing.

[63]  K. Kaneda,et al.  A Double-Masked Multicenter Comparative Study Between Alendronate and Alfacalcidol in Japanese Patients with Osteoporosis , 1999, Osteoporosis International.

[64]  L J Donaldson,et al.  Incidence of fractures in a geographically defined population. , 1990, Journal of epidemiology and community health.

[65]  G. Lyritis,et al.  Effect of nandrolone decanoate and 1-alpha-hydroxy-calciferol on patients with vertebral osteoporotic collapse. A double-blind clinical trial. , 1994, Bone and mineral.

[66]  G. Spears,et al.  Treatment of postmenopausal osteoporosis with calcitriol or calcium. , 1992, The New England journal of medicine.

[67]  R. Epstein,et al.  Pre-existing fractures and bone mass predict vertebral fracture incidence in women. , 1991, Annals of internal medicine.

[68]  R. Goodman,et al.  The effect of risedronate on the risk of hip fracture in elderly women. , 2001, The New England journal of medicine.

[69]  R. Hanka.  The Handbook of Research Synthesis , 1994 .

[70]  C D Naylor,et al.  Incorporating variations in the quality of individual randomized trials into meta-analysis. , 1992, Journal of clinical epidemiology.

[71]  C. Cooper,et al.  Vertebral Fractures Predict Subsequent Fractures , 1999, Osteoporosis International.

[72]  H. Orimo,et al.  Effects of 2 years' treatment of osteoporosis with 1 alpha-hydroxy vitamin D3 on bone mineral density and incidence of fracture: a placebo-controlled, double-blind prospective study. , 1996, Endocrine journal.

[73]  D. Torgerson,et al.  Cost analysis of fracture of the neck of femur. , 1995, Age and ageing.

[74]  P. Meunier.  Calcium, Vitamin D and Vitamin K in the Prevention of Fractures due to Osteoporosis , 1999, Osteoporosis International.

[75]  J. Kanis,et al.  An Update on the Diagnosis and Assessment of Osteoporosis with Densitometry , 2000, Osteoporosis International.

[76]  K. Yaffe,et al.  Estrogen therapy in postmenopausal women: effects on cognitive function and dementia. , 1998, JAMA.

[77]  P. Dolan,et al.  Modeling valuations for EuroQol health states. , 1997, Medical care.

[78]  R. Westendorp,et al.  Cardioprotective effect of hormone replacement therapy in postmenopausal women: is the evidence biased? , 1994, BMJ.

[79]  J. Flaws,et al.  Effects of raloxifene in postmenopausal women. , 1998, The New England journal of medicine.

[80]  J. Kanis.  The use of calcium in the management of osteoporosis. , 1999, Bone.

[81]  M. Weinstein,et al.  Cost-effectiveness of hormone replacement therapy in the menopause. , 1983, Obstetrical & gynecological survey.

[82]  U Brägger,et al.  Particulate bioglass as a grafting material in the treatment of periodontal intrabony defects. , 1997, Journal of clinical periodontology.

[83]  F Duboeuf,et al.  Vitamin D3 and calcium to prevent hip fractures in elderly women. , 1992, The New England journal of medicine.

[84]  G. Penney,et al.  A population based survey of women's experience of the menopause , 1996, British journal of obstetrics and gynaecology.

[85]  James,et al.  Fractured Neck of Femur: Prevention and Management , 1989, Journal of the Royal College of Physicians of London.

[86]  N. Wintfeld,et al.  Postmenopausal hormone therapy and mortality. , 1997, The New England journal of medicine.

[87]  S. Cummings,et al.  Non-trauma mortality in elderly women with low bone mineral density , 1991, The Lancet.

[88]  P. Meunier.  Oral alendronate increases bone mineral density and reduces vertebral fracture incidence in postmenopausal osteoporosis , 1997 .

[89]  D. Torgerson,et al.  The economics of osteoporosis prevention , 1997, Trends in Endocrinology & Metabolism.

[90]  D. Gold.  The clinical impact of vertebral fractures: quality of life in women with osteoporosis. , 1996, Bone.

[91]  Olof Johnell,et al.  Hormone replacement therapy and risk of hip fracture: population based case-control study , 1998, BMJ.

[92]  P. Meunier,et al.  Fluoride and vertebral fractures , 1990, The Lancet.

[93]  I. Matheson,et al.  Postmenopausal osteoporosis: no effect of three years treatment with 1,25-dihydroxycholecalciferol. , 2009, Acta medica Scandinavica.

[94]  J. Davis,et al.  Effect of thiazide on rates of bone mineral loss: a longitudinal study. , 1990, BMJ.

[95]  A. Hofman,et al.  Thiazide Diuretics and the Risk for Hip Fracture , 2003, Annals of Internal Medicine.

[96]  T. Fujita.  Double-blind multicenter comparative study with alfacalcidol of etidronate disodium (EHDP) in involutional osteoporosis , 1993 .

[97]  I Larzillière,et al.  [Esophagitis associated with the use of alendronate]. , 1999, Gastroenterologie clinique et biologique.

[98]  G. Blake,et al.  Quantitative Ultrasound and Bone Mineral Density Are Equally Strongly Associated with Risk Factors for Osteoporosis , 2001, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[99]  S. Cummings,et al.  The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. , 1999, JAMA.

[100]  J. Berthelot,et al.  Adjusting Life Expectancy to Account for Disability in a Population: A Comparison of Three Techniques , 1999 .

[101]  W. Nelp,et al.  Stanozolol in postmenopausal osteoporosis: therapeutic efficacy and possible mechanisms of action. , 1983, Metabolism: clinical and experimental.

[102]  C. Christiansen,et al.  A 2-Year Phase II Study with 1-Year of Follow-up of Risedronate (NE-58095) in Postmenopausal Osteoporosis , 1997, Osteoporosis International.

[103]  J Pearson,et al.  Prevalent Vertebral Deformities Predict Hip Fractures and New Vertebral Deformities but Not Wrist Fractures , 1999, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[104]  B. Dawson-Hughes,et al.  Effect of withdrawal of calcium and vitamin D supplements on bone mass in elderly men and women. , 2000, American Journal of Clinical Nutrition.

[105]  S. Cummings,et al.  Estrogen Replacement Therapy and Fractures in Older Women , 1995, Annals of Internal Medicine.

[106]  W. Wallace,et al.  Hormone Replacement Therapy Acceptability to Nottingham Post-Menopausal Women with a Risk Factor for Osteoporosis , 1990, Journal of the Royal Society of Medicine.

[107]  C. Cooper,et al.  Population-based study of survival after osteoporotic fractures. , 1993, American journal of epidemiology.

[108]  H. Jacobs.  Exogenous oestrogens and the risk of breast cancer , 2000 .

[109]  L. Avioli,et al.  Coherence therapy does not prevent axial bone loss in osteoporotic women: a preliminary comparative study. , 1988, The Journal of clinical endocrinology and metabolism.

[110]  D. Hunninghake,et al.  Effects of a vigorous walking program on body composition, and carbohydrate and lipid metabolism of obese young men. , 1979, The American journal of clinical nutrition.

[111]  S. Ott,et al.  Calcitriol treatment is not effective in postmenopausal osteoporosis. , 1989, Annals of internal medicine.

[112]  F. Ennas,et al.  Ipriflavone-treatment of senile osteoporosis: results of a multicenter, double-blind clinical trial of 2 years. , 1994, Archives of gerontology and geriatrics.

[113]  J. Kanis.  What Constitutes Evidence for Drug Efficacy in Osteoporosis? , 1993, Drugs & aging.

[114]  Jennifer A. Roberts,et al.  Cost analysis of early discharge after hip fracture. , 1993, BMJ.

[115]  J. Wark,et al.  The prevention and treatment of osteoporosis. , 1993, The New England journal of medicine.

[116]  S. Cummings,et al.  Bone Mineral Density and Risk of Breast Cancer in Older Women: The Study of Osteoporotic Fractures , 1996 .

[117]  J. Aloia,et al.  Calcitriol in the treatment of postmenopausal osteoporosis. , 1988, The American journal of medicine.

[118]  M. Weinstein.  Estrogen use in postmenopausal women--costs, risks, and benefits. , 1980, The New England journal of medicine.

[119]  O. Johnell,et al.  Therapeutic strategies in the prevention of hip fracture with drugs affecting bone metabolism. , 1993, Bone.

[120]  S. Cummings,et al.  Which Fractures Are Associated with Low Appendicular Bone Mass in Elderly Women , 1991 .

[121]  O Johnell,et al.  Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. , 1996, BMJ.

[122]  Tammy O. Tengs,et al.  One thousand health-related quality-of-life estimates. , 2000, Medical care.

[123]  D. Atkins.  Postmenopausal estrogen therapy and cardiovascular disease. , 1992, The New England journal of medicine.

[124]  B. Riggs,et al.  Treatment of Established Postmenopausal Osteoporosis with Raloxifene: A Randomized Trial , 1998, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[125]  A P Cheung,et al.  A cost‐effectiveness analysis of hormone replacement therapy in the menopause∗ , 1992, The Medical journal of Australia.

[126]  F. Grodstein,et al.  Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. , 1999, The American journal of medicine.

[127]  S Ziebland,et al.  A comparison of the sensitivity to change of several health status instruments in rheumatoid arthritis. , 1993, The Journal of rheumatology.

[128]  D. Kiel,et al.  Hip fracture and the use of estrogens in postmenopausal women. The Framingham Study. , 1987, The New England journal of medicine.

[129]  S. Hizmetli,et al.  THE EFFECT OF DIFFERENT DOSES OF CALCITONIN ON BONE MINERAL DENSITY AND FRACTURE RISK IN POSTMENOPAUSAL OSTEOPOROSIS , 1998, International journal of clinical practice.

[130]  M. Shiraki,et al.  Vitamin K2 (Menatetrenone) Effectively Prevents Fractures and Sustains Lumbar Bone Mineral Density in Osteoporosis , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[131]  P. Geusens,et al.  Bone mineral content, cortical thickness and fracture rate in osteoporotic women after withdrawal of treatment with nandrolone decanoate, 1-alpha hydroxyvitamin D3, or intermittent calcium infusions. , 1986, Maturitas.

[132]  O. Johnell,et al.  Risk factors for hip fracture in european women: The MEDOS study , 1995 .

[133]  W. Lems,et al.  Is addition of sodium fluoride to cyclical etidronate beneficial in the treatment of corticosteroid induced osteoporosis? , 1996, Annals of the rheumatic diseases.

[134]  D. Torgerson,et al.  Hormone replacement therapy: compliance and cost after screening for osteoporosis. , 1995, European Journal of Obstetrics, Gynecology, and Reproductive Biology.

[135]  L. Joseph Melton,et al.  LONG-TERM USE OF THIAZIDE DIURETICS AND RISK OF HIP FRACTURE , 1989, The Lancet.

[136]  J. Gallagher,et al.  Treatment of postmenopausal osteoporosis with high doses of synthetic calcitriol. A randomized controlled study. , 1990, Annals of internal medicine.

[137]  P. Tugwell,et al.  Fluoride for the Treatment of Postmenopausal Osteoporotic Fractures: A Meta-Analysis , 2000, Osteoporosis International.

[138]  M. Gold.  Cost-effectiveness in health and medicine , 2016 .

[139]  P. Jaeger,et al.  Incidence and Direct Medical Costs of Hospitalizations due to Osteoporotic Fractures in Switzerland , 1997, Osteoporosis International.

[140]  John Brazier,et al.  A review of the use of health status measures in economic evaluation. , 1999, Health technology assessment.

[141]  M. Weinstein,et al.  Cost‐Effectiveness of Hormone Replacement , 1990, Annals of the New York Academy of Sciences.

[142]  L. Kuller,et al.  Effects of raloxifene on serum lipids and coagulation factors in healthy postmenopausal women. , 1998, JAMA.

[143]  T A Einhorn,et al.  Fractures Attributable to Osteoporosis: Report from the National Osteoporosis Foundation , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[144]  G. Chapman,et al.  [Medical decision making]. , 1976, Lakartidningen.

[145]  S. H. Kan,et al.  Lifetime fracture risk: an approach to hip fracture risk assessment based on bone mineral density and age. , 1988, Journal of clinical epidemiology.

[146]  J. Ringe,et al.  Salmon calcitonin in the therapy of corticoid-induced osteoporosis , 2004, European Journal of Clinical Pharmacology.

[147]  R. Klein,et al.  The Beaver Dam Health Outcomes study , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[148]  J. Ringe.  [Treatment of primary osteoporosis with calcium and salmon calcitonin]. , 2008, Deutsche medizinische Wochenschrift.

[149]  J Raftery,et al.  NICE: faster access to modern treatments? Analysis of guidance on health technologies , 2001, BMJ : British Medical Journal.

[150]  P. Sambrook,et al.  The Role of Calcitriol in the Treatment of Osteoporosis , 2000, Calcified Tissue International.

[151]  A. Gray,et al.  HRT: an analysis of benefits, risks and costs. , 1992, British medical bulletin.

[152]  M. Passeri,et al.  Effect of ipriflavone on bone mass in elderly osteoporotic women. , 1992, Bone and mineral.

[153]  D. Whynes,et al.  The Costs of Treating Breast Cancer in the United Kingdom: Implications for Screening , 1998, International Journal of Technology Assessment in Health Care.

[154]  H K Genant,et al.  Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. , 1999, JAMA.

[155]  A. Milner,et al.  Effect of sodium fluoride, inorganic phosphate, and oxymetholone therapies in osteoporosis: a six-year progress report. , 1978, Journal of gerontology.

[156]  D. Torgerson,et al.  Health-Related Quality of Life of Colles’ Fracture Patients , 1999, Osteoporosis International.

[157]  R. Recker,et al.  Effect of Oral Alendronate on Bone Mineral Density and the Incidence of Fractures in Postmenopausal Osteoporosis , 1996 .

[158]  A. Pontiroli,et al.  Intranasal and intramuscular human calcitonin in female osteoporosis and in Paget’s disease of bones: a pilot study , 1991, Journal of endocrinological investigation.

[159]  S. Wimalawansa.  A four-year randomized controlled trial of hormone replacement and bisphosphonate, alone or in combination, in women with postmenopausal osteoporosis. , 1998, The American journal of medicine.

[160]  R. Recker,et al.  Correcting calcium nutritional deficiency prevents spine fractures in elderly women , 1996, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[161]  S. Cummings,et al.  Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures , 1996, The Lancet.

[162]  A. O'Hagan,et al.  Curve Fitting and Optimal Design for Prediction , 1978 .

[163]  N J Wald,et al.  By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? , 1994, BMJ.

[164]  M. Revilla,et al.  Salmon calcitonin reduces vertebral fracture rate in postmenopausal crush fracture syndrome. , 1992, Bone and mineral.

[165]  R. Wallace,et al.  Costs and health effects of osteoporotic fractures. , 1994, Bone.

[166]  K. Kerlikowske,et al.  Hormone replacement therapy and endometrial cancer risk: a meta-analysis. , 1995, Obstetrics and gynecology.

[167]  W. Hollingworth,et al.  The cost of treating hip fractures in the twenty-first century. , 1995, Journal of public health medicine.

[168]  S. Gonnelli,et al.  Comparative effects on bone mineral content of calcium and calcium plus salmon calcitonin given in two different regimens in postmenopausal osteoporosis , 1985 .

[169]  J. Reisch,et al.  Slow-Release Sodium Fluoride in the Management of Postmenopausal Osteoporosis , 1994, Annals of Internal Medicine.

[170]  O. Johnell,et al.  Cost-effectiveness of fracture prevention in established osteoporosis. , 1996, Scandinavian journal of rheumatology. Supplement.

[171]  A. Hardman,et al.  Brisk walking and plasma high density lipoprotein cholesterol concentration in previously sedentary women. , 1989, BMJ.

[172]  R. Cumming,et al.  Quality of life related to fear of falling and hip fracture in older women: a time trade off study. , 2000, BMJ.

[173]  J. Eisman,et al.  Mortality after all major types of osteoporotic fracture in men and women: an observational study , 1999, The Lancet.

[174]  P. Kannus,et al.  Secular trends in the osteoporotic fractures of the distal humerus , 1998, European Journal of Epidemiology.

[175]  A Laupacis,et al.  Assessing the quality of randomized trials: reliability of the Jadad scale. , 1999, Controlled clinical trials.

[176]  J Townsend,et al.  Cost effectiveness scenario analysis for a proposed trial of hormone replacement therapy. , 1997, Health policy.

[177]  O. Johnell,et al.  Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture. , 1992, BMJ.

[178]  D. Felsenberg,et al.  Multinational, Placebo-Controlled, Randomized Trial of the Effects of Alendronate on Bone Density and Fracture Risk in Postmenopausal Women with Low Bone Mass: Results of the FOSIT Study , 1999, Osteoporosis International.

[179]  J. Kanis,et al.  Effect of calcitonin on vertebral and other fractures. , 1999, QJM : monthly journal of the Association of Physicians.

[180]  J. Eisman,et al.  Thiazide diuretics and fractures: Can meta‐analysis help? , 1995, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[181]  E. Harju,et al.  Annual injection of vitamin D and fractures of aged bones , 1992, Calcified Tissue International.

[182]  O. Johnell,et al.  Effect and Offset of Effect of Treatments for Hip Fracture on Health Outcomes , 1999, Osteoporosis International.

[183]  M. A. Hansen,et al.  Effect of salcatonin given intranasally on bone mass and fracture rates in established osteoporosis: a dose-response study. , 1992, BMJ.

[184]  L. Hedlund,et al.  The Effect of Fluoride in Osteoporosis. , 1987 .

[185]  W. Murphy,et al.  Effect of oral 1,25-dihydroxyvitamin D and calcium on glucocorticoid-induced osteopenia in patients with rheumatic diseases. , 1984, Arthritis and rheumatism.

[186]  T. Abbott,et al.  Patients with Prior Fractures Have an Increased Risk of Future Fractures: A Summary of the Literature and Statistical Synthesis , 2000, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[187]  J. Cauley,et al.  Risk of Mortality Following Clinical Fractures , 2000, Osteoporosis International.

[188]  B. Kirby,et al.  Cost implications of cardiac rehabilitation in older patients. , 1999, Coronary artery disease.

[189]  C. Albanese,et al.  Bone densitometry in the clinical practice , 1997, European Radiology.

[190]  B. Adams-Huet,et al.  Treatment of Postmenopausal Osteoporosis with Slow-Release Sodium Fluoride: Final Report of a Randomized Controlled Trial , 1995, Annals of Internal Medicine.

[191]  H. Genant,et al.  Effect of Intermittent Cyclical Etidronate Therapy on Bone Mass and Fracture Rate in Women with Postmenopausal Osteoporosis , 1990 .

[192]  A. LaCroix,et al.  Thiazide diuretic agents and the incidence of hip fracture. , 1990, The New England journal of medicine.

[193]  H. Meyer,et al.  Factors Associated with Mortality after Hip Fracture , 2000, Osteoporosis International.

[194]  I. Reid,et al.  Continuous therapy with pamidronate, a potent bisphosphonate, in postmenopausal osteoporosis. , 1994, The Journal of clinical endocrinology and metabolism.

[195]  W M O'Fallon,et al.  Determinants of Reduced Survival Following Hip Fractures in Men , 1995, Clinical orthopaedics and related research.

[196]  E. Barrett-Connor,et al.  Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial. , 1997, Archives of internal medicine.

[197]  D. Torgerson,et al.  The Cost of Treating Osteoporotic Fractures in the United Kingdom Female Population , 1998, Osteoporosis International.

[198]  Intermittent cyclical etidronate treatment of postmenopausal osteoporosis. , 1990, The New England journal of medicine.

[199]  S. Lo,et al.  Fracture incidence in England and Wales: a study based on the population of Cardiff. , 1997, Injury.

[200]  O. Johnell,et al.  Lifetime Risk of Hip Fractures is Underestimated , 1998, Osteoporosis International.

[201]  D Elbourne,et al.  The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials , 1988, British journal of obstetrics and gynaecology.

[202]  H. Genant,et al.  Effect of intermittent cyclical etidronate therapy on bone mass and fracture rate in women with postmenopausal osteoporosis. , 1990, The New England journal of medicine.

[203]  A. O’Cathain.  Evaluation of a Hospital at Home scheme for the early discharge of patients with fractured neck of femur. , 1994, Journal of public health medicine.

[204]  D. Kiel,et al.  Bone mass and the risk of breast cancer among postmenopausal women. , 1997, The New England journal of medicine.

[205]  John A. Kants.  Treatment of osteoporosis in elderly women. , 1995 .

[206]  B. Riggs,et al.  Raloxifene hydrochloride, a selective estrogen receptor modulator: safety assessment of effects on cognitive function and mood in postmenopausal women , 1999, Psychoneuroendocrinology.

[207]  M. Horowitz,et al.  Cross-over study of fat-corrected forearm mineral content during nandrolone decanoate therapy for osteoporosis. , 1989, Bone.

[208]  A. Lane,et al.  Treatment of Postmenopausal Osteoporosis with Transdermal Estrogen , 1992, Annals of Internal Medicine.

[209]  L. Kuller,et al.  Estrogen replacement therapy and mortality among older women. The study of osteoporotic fractures. , 1997, Archives of internal medicine.

[210]  David J Torgerson,et al.  Prescribing by general practitioners after an osteoporotic fracture , 1998, Annals of the rheumatic diseases.

[211]  E. Vittinghoff,et al.  Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. , 1998, JAMA.

[212]  J. Kanis,et al.  Elimination and Biochemical Responses to Intravenous Alendronate in Postmenopausal Osteoporosis , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[213]  R. Lindsay,et al.  BONE RESPONSE TO TERMINATION OF OESTROGEN TREATMENT , 1978 .

[214]  J. Tucci,et al.  Effect of three years of oral alendronate treatment in postmenopausal women with osteoporosis. , 1996, The American journal of medicine.

[215]  A. Prost,et al.  RISK-BENEFIT RATIO OF SODIUM FLUORIDE TREATMENT IN PRIMARY VERTEBRAL OSTEOPOROSIS , 1988, The Lancet.

[216]  H. Genant,et al.  Cyclical etidronate in the treatment of postmenopausal osteoporosis: efficacy and safety after seven years of treatment. , 1997, The American journal of medicine.

[217]  A. Hofman,et al.  Incremental Cost of Medical Care after Hip Fracture and First Vertebral Fracture: The Rotterdam Study , 1999, Osteoporosis International.

[218]  B. Riggs,et al.  The Effect of Calcitriol on Patients with Postmenopausal Osteoporosis with Special Reference to Fracture Frequency , 1989, Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine.