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Boonen S et al. – Although treatment persistence is an important factor in reducing fracture risk, when comparing the health economic data of several treatment options, studies have shown that the cost–effectiveness of bisphosphonate therapy is mainly dependent on drug efficacy rather than persistence or dosing frequency. It should also be noted that fractures at different skeletal sites have different economic impacts. Non–vertebral fractures (and particularly those of the hip) are more costly than vertebral fractures. Although persistence with osteoporosis therapy is an important factor in reducing fracture risk, it has less of an impact on cost–effectiveness than treatment efficacy, in particular efficacy at non–vertebral sites.

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