April 15, 2009

Critique of Osteoporosis as a Disease and Related Drug Concerns

Osteoporosis, a loss of bone mass that can precede serious and costly breaks or fractures, is of particular concern to women – current estimates suggest that “osteoporosis is a major public health threat for 44 million Americans, 68 percent of whom are women… One out of every two women and one in four men age 50 and older will have an osteoporosis-related fracture in their lifetime.”

Often overlooked in discussions of the condition, however, are questions related to the efficacy and potential harms of the tests and treatments used to measure and prevent bone loss.  In particular, women’s health advocates have concerns about the overuse of medications in women who have risk factors for osteoporosis, but do not actually have the disease itself.

The April issue of the American Journal of Nursing (AJN) includes a piece, “The Marketing of Osteoporosis,” which comments on the promotion of drugs to symptom-free women for bone fracture prevention.

Author Maryann Napoli (of the Center for Medical Consumers) writes:

“In the name of prevention, millions of Americans have accepted the idea that it’s reasonable to treat a risk factor such as bone loss or high cholesterol as if it were a disease…More people should question the wisdom of starting long-term drug therapy. Often the magnitude of the risk factor has been overestimated, or the danger of the disease itself exaggerated, by people trying to sell you something-like a drug you must take for the rest of your life.”

She describes how what was once a risk factor (bone loss) came to be thought of as a disease (osteoporosis), and notes the role of pharmaceutical companies such as Merck in shaping this thinking, as well as in encouraging women to have bone density scans and take drugs as a “preventive” measure.

Napoli notes that as drugs such as alendronate came on the market, middle-aged rather than elderly women became the targets of osteoporosis-related advertising and drugs. She explains:

“A multipage glossy ad campaign that ran frequently in the Annals of Internal Medicine, for example, featured a thin, 40-something white woman with a crumbling ancient stone column in the background. “Don’t wait for a fracture…. No matter what her degree of osteoporotic bone loss.” I wrote to the editor-in-chief of Annals, pointing out that alendronate had no proven benefit in women in early middle age or in those without a history of fracture. I never received a reply, but the journal stopped running the ad about six months later….

Today, women in the osteoporosis drug ads are usually in their early 60s. The 2002 guidelines for osteoporosis screening from the Agency for Healthcare Research and Quality recommend that bone-density scanning not begin until age 65 (or 60 in some high-risk cases).”

Christine has previously written about the potentially serious side effects medications for postmenopausal osteoporosis and non-drug prevention options, and OBOS’s Judy Norsigian and Heather Stephenson addressed the issue in a commentary for Women’s eNews, “Let’s Make May the Month to Tame Osteoporosis Hype.”

Side note: The current cover of the AJN features a piece of art called Nursing Bra, part of the Artfull Bras Project, a collection of 50 bras created by the Quilters of South Carolina to raise breast cancer awareness.


3 Responses to “Critique of Osteoporosis as a Disease and Related Drug Concerns”

  1. mrs spock Says:

    Great post! As a nurse reviewer at an insurance company, I see hundreds upon hundreds of requests each day for osteoporosis agents- particularly the ones most heavily marketed in TV and print ads. Alendronate and other bisphosphonates can have unpleasant and even serious GI side effects. Who wants to take a pill or even a yearly injection when regular weight-bearing exercise will increase bone-mineral density, keep weight down, and help maintain heart health? There are certainly patients who would benefit from drug therapy, but it should not be the first plan of attack for most women.

    http://www.eurekalert.org/pub_releases/2006-02/msl-rst020106.php

  2. Judith Lienhard Says:

    I was so happy to see this article in AJN since so often I feel that nursing journals give medication info that supports the pharma companies without questioning anything. There is also a great chapter on “osteoporosis” in the book “Worried Sick”, a book I highly recommend for the content if not the style.

  3. labornurse@nursingjobs.org Says:

    thanks for this post. One of the things that this made me think of was that biphosphonates is for the treatment of osteoporosis- not prevention. I often wonder if these ads are meant to confuse consumers because they discuss “prevention”. What they are meant to prevent are stress fractures. The problem is that biphosphonates do a better job at increasing bone mass in conjunction with calcium, vitamin d, and weight bearing exercise as opposed to the latter alone. Does this mean every woman needs to be on it? Probably not. I think these drugs have their place, and would recommend them to women who would benefit from them; especially if it meant it would prevent a stress fracture.

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