The relative risks for men with PVFs were taken from a meta-analysis and were 2.3, 4.4, 1.4 and 1.8 for hip, clinical vertebral, wrist and other fractures, respectively [42]. These relative risks were reduced by 10 % each per decade above the age of 70 years [43]. An increased risk of subsequent fractures was also modelled during the simulation for men who have a prior fracture of the same location, using a previously described method [18]. Strontium ranelate The MALEO Trial has been developed in accordance with European guideline on clinical investigation of medicinal products

(November 2006). This guideline deals with minimal requirement for marketing indication of DAPT a treatment in osteoporosis in men at increased risk fracture once the marketing indication in PMO women has been already granted to the same drug. The MALEO Trial is a controlled study versus placebo on the basis of calcium/vit D supplementation with BMD measure as primary efficacy criteria and a main analysis after 1 year.

In the MALEO Trial [15], Selleck Inhibitor Library a marked increase in the mean lumbar L2–L4 and femoral neck BMD was observed in men with high risk of fractures, similar to that previously observed in women (Table 2). Considering these results and the previously established relationship between change in BMD and reduction in the risk of vertebral and hip fractures with strontium ranelate in women [44, 45], a similar anti-fracture efficacy is expected in men. We therefore assumed, in the base-case analysis, the same relative risk reduction of fractures in men as those estimated in women (SOTI and TROPOS trials). Table 2 Between treatment comparison Mannose-binding protein-associated serine protease of the percentage change in lumbar spine and femoral neck BMD to month 12 relative to baseline in male patients from MALEO and in postmenopausal women in SOTI-TROPOS studies Relative change from baseline to M12 Men with osteoporosis PMO women   MALEO N=261 (15) TROPOS N=5,091 (7) SOTI N=1,649 (5) Lumbar spine BMD N 197 3807 1361 E (SE) 6.2 (0.8)% 7.0 (0.2)% 7.2 (0.4)% 95 % CI [4.7–7.8]

[6.6–7.4] [6.5–7.9] p value p<0.001 p<0.001 p<0.001 Femoral neck BMD N 178 3,759 1,326 E (SE) 3.2 (0.7)% 3.6 (0.2)% 3.3 (0.2)% 95 % CI [1.8–4.6] [3.3–3.9] [2.8–3.8] p value p<0.001 p<0.001 p<0.001 N number of patients with evaluation at both baseline and M12 visits, E (SE) estimate and standard error of the adjusted mean difference (strontium ranelate vs. placebo), CI confidence interval of the estimate, PMO Post-menopausal osteoporosis In most cost-effectiveness analyses, efficacy data were retrieved from the entire population of the randomized clinical trials and the modelers charged the full treatment cost. Although, in real-life settings, adherence is far from optimal, this assumption may be incorrect to estimate the potential economic value of a drug and probably underestimates the true underlying risk reduction with therapy since the efficacy from these trials is reduced to some degree because of non-adherence.