Osteoporosis is a disease that causes bones to become thinner, more porous and break more easily. Osteopenia is different from osteoporosis — it is a slight thinning of bones that occurs naturally as women get older and typically doesn’t result in disabling bone breaks.
Osteopenia is a condition that only recently started to be thought of as a problem that required treatment. Until the early 1990’s, only a handful of people had even heard of the word. But osteopenia has transformed from a rarely heard word into a problem that millions of women swallow pills to treat.
The term “osteopenia” was never originally meant to be considered as a disease — it was a research category used mostly because some thought it might be useful for public health researchers who like clear categories for their studies.
But in 1995, a man named Jeremy Allen was approached by the drug company Merck. The pharmaceutical giant had just released a new osteoporosis drug called Fosamax. Since osteoporosis is a serious problem that affects millions of women, the potential market for Fosamax was enormous. But the drug wasn’t selling well.
Allen persuaded Merck to establish a nonprofit called the Bone Measurement Institute. On its board were six of the most respected osteoporosis researchers in the country.
But the institute itself had a rather slim staff: Allen was the only employee.
In 1997 the institute and several other interested organizations successfully lobbied to pass the Bone Mass Measurement Act, a piece of legislation that changed Medicare reimbursement rules to cover bone scans. More and more women got bone density tests (at Merck’s urging), and the very existence of the word “osteopenia” on a medical report had a profound effect.
Millions of women were worried by the diagnosis. And when clinicians saw the word ‘osteopenia’ on a report, they assumed it was a disease. Merck did not disabuse them of the notion.
There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50’s and continue treatment long-term in the hopes of preventing old-age fractures. And none are planned.
Dr. Court’s Comments
This never fails to amaze me that pharmaceutical giants can actually get conditions that have literally almost not risk associated with them to be classified as disease. According the the British Medical Journal, counterpart to our Journal of the American Medical Association, the strongest risk factor for fractures in women is falling, not osteoporosis. What is very interesting is that vitamin D has been shown to reduce falls in elderly women, but you don’t hear about that on the nightly news.
Here is a quote from the very study that shows osteoporosis drug use is overstated and exxagerated.
What the drug makers do is argue that the effect of treating pre-osteoporosis (osteopenia) and osteoporosis is similar. This move to treat pre-osteoporosis raises serious questions about the benefit-risk relationship for low-risk individuals and about the costs of medicalizing and potentially medicating an enormous group of healthy people.
It is clear that these drugs are dangerous. I am not suggesting that they do not benefit a small portion of the population who have moderate to severe osteoporosis. The problem is that most people are not told about conservative ways to treat their thinning bones. These include things like calcium, vitamin D and vitamin K supplementation. They also include weight bearing exercise. The drug companies would have you believe they benefit everyone. The pharmaceutical companies manipulate research, congress and the public to get their agendas passed and they do it so carefully that these things become “fact” when, in reality, there is little evidence that what they state is real.