July 14, 1999
NEW YORK, July 12 - Osteoporotic hip fractures are largely preventable with the intake of recommended levels of calcium and vitamin D, weight-bearing exercise and medications when appropriate. Yet every year, nearly 300,000 American women and men suffer hip fractures, and usually require hospitalization and major surgery.
Is the old adage, an ounce of prevention is worth a pound of cure, true for hip fractures? Would the savings in medical costs from preventing hip fractures outweigh the cost of calcium supplementation for Americans at risk? This is what Adrianne Bendich, Ph.D., Shelah Leader, Ph.D. and Pradip Muhuri, Ph.D., wanted to determine in their new study, "Supplemental Calcium for the Prevention of Hip Fracture: Potential Health-Economic Benefits."
Drs. Bendich, Leader and Muhuri have concluded that 134,764 hip fractures and $2.6 billion of direct medical costs would have been avoided in 1995 if hip fracture patients age 50 or older had consumed about 1,200 mg/day of supplemental calcium for 34 months. They found that further health care savings could also be expected, because calcium supplementation can significantly reduce all non-vertebral fractures. The complete results of their study, which was underwritten by SmithKline Beecham, makers of TUMS(R), appear in the June 1999 issue of Clinical Therapeutics.
The human and economic consequences of hip fractures can be enormous. Their data analysis shows that in 1995, 290,327 patients age 50 or older were discharged from U.S. hospitals with a primary diagnosis of hip fracture, at an estimated direct cost of $5.6 billion. The average hospital stay for such patients was 8.4 days. About half the female patients 65+ years and nearly 57% of those age 85+ are sent to long term care facilities following hospitalization. Many patients never fully recover from their injuries. The costs for associated medical treatment increase each year.
Analyzing three published articles* based on double-blind, placebo-controlled clinical trials of the effects of calcium supplementation; data from the National Health and Nutrition Survey 1988-94 (NHANES III), the 1995 National Hospital Discharge Survey and the U.S. Bureau of the Census; proprietary market information on the cost of calcium supplements; and other primary and secondary sources, Drs. Bendich, Leader and Muhuri compared the projected savings in direct health care costs with the cost of supplements that provide the level of calcium associated with hip fracture reduction (1,200 mg/day of elemental calcium for 34 months).
The National Institutes of Health and the National Academy of Sciences recommend post-menopausal women should be getting between 1,200 and 1,500 mg of elemental calcium each day. However, a telephone survey of U.S. households discovered that the average daily intake of calcium for adults 60-94 years old falls far short of this amount; sometimes less than half of what is needed. The authors' analysis of unpublished raw data on vitamin and mineral usage from the Dietary Supplement to the NHANES III revealed that only about two percent (2%) of adults 50 years or older take any form of calcium supplements. " Compared to expensive medical procedures and the stays in long term care facilities associated with hip fracture recovery," points out Dr. Bendich, "the cost of 1,200 mg/day of calcium supplementation as a preventive measure is minimal; less than $50 a year per person."
The evidence Drs. Bendich, Leader and Muhuri found in their study encourages all adults, especially those 65 or older, not only to increase their intake of dietary calcium, but to consider using calcium supplements as well, to prevent hip fractures.
Daily consumption of 1,200 mg of supplemental calcium by all U.S. women 75 years of age or older was found to be cost-effective, based upon 34 months of supplementation. If the same reduction in hip fracture risk can be achieved in less time, then calcium supplements are cost-effective for all Americans age 65 and older.
Even small increases in supplementation are predicted to yield savings for the Medicare program, which covers more than 80% of the costs associated with hip fractures for patients age 65+.
"More important," says Dr. Bendich, "it can also significantly reduce the toll of human suffering and death associated with hip fractures. "
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SOURCE SmithKline Beecham