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Public Health Nutr. 2017 Jul;20(10):1874-1883. doi: 10.1017/S1368980015003171. Epub 2015 Nov 16.

Economic evaluation of vitamin D and calcium food fortification for fracture prevention in Germany.

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1Department of Osteology and Biomechanics,University Medical Center Hamburg-Eppendorf,Martinistraße 52,D-20246 Hamburg,Germany.
2Department of Health Economics and Health Services Research,Hamburg Center for Health Economics,University Medical Center Hamburg-Eppendorf,Hamburg,Germany.



The study evaluates the economic benefit of population-wide vitamin D and Ca food fortification in Germany.


Based on a spreadsheet model, we compared the cost of a population-wide vitamin D and Ca food-fortification programme with the potential cost savings from prevented fractures in the German female population aged 65 years and older.


The annual burden of disease and the intervention cost were assessed for two scenarios: (i) no food fortification; and (ii) voluntary food fortification with 20 µg (800 IU) of cholecalciferol (vitamin D3) and 200 mg of Ca. The analysis considered six types of fractures: hip, clinical vertebral, humerus, wrist, other femur and pelvis.


Subgroups of the German population defined by age and sex.


The implementation of a vitamin D and Ca food-fortification programme in Germany would lead to annual net cost savings of €315 million and prevention of 36 705 fractures in the target population.


Vitamin D and Ca food fortification is an economically beneficial preventive health strategy that has the potential to reduce the future health burden of osteoporotic fractures in Germany. The implementation of a vitamin D and Ca food-fortification programme should be a high priority for German health policy makers because it offers substantial cost-saving potential for the German health and social care systems.


Cost savings; Deficiency; Economic evaluation; Food fortification; Fracture prevention; Nutrition policy; Vitamin D

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