Daniel Solomon

Daniel Solomon, MD, MPH

It is estimated that for every 10,000 post-fracture patients, a Fracture Liaison Service (FLS) program would result in 153 fewer fractures and about 37 more quality-adjusted life years. It would also save nearly $67,000 compared with typical post-fracture care.

Daniel Solomon, MD, MPH, BWH Division of Rheumatology, Immunology and Allergy and National Bone Health Alliance Executive Committee member; John Schousboe, MD, PhD, CCD, International Society for Clinical Densitometry president; and colleagues assessed the cost-effectiveness of FLS programs from a health care system perspective. They found that despite the fact that fractures related to osteoporosis are associated with $20 billion in costs in the United States, the FLS developed in many health systems has not been widely implemented in the country.

To conduct the study, authors developed a Markov state-transition computer simulation model. Using the model, they projected the lifetime costs and benefits of FLS, with or without a bone mineral density test, in men and women who had experienced a hip fracture. They were able to estimate the costs and benefits of an FLS, the probabilities of re-fracture while on osteoporosis treatment, and the utilities associated with various health states from published literature.

They concluded that FLS programs targeting patients post-hip fracture should result in cost-savings and reduced fractures under most scenarios. “It is unusual to find that adding health care services actually reduces costs, but that is exactly what we found for the FLS,” said Solomon. “Improved funding for an FLS is an example of how the United States health care system could ‘bend the cost curve’ while improving care.”

The study was published online Jan. 20, 2014 in the Journal of Bone and Mineral Research.