A few weeks ago, one of our customers called. At a recent appointment her doctor expressed shocked concern that her Bone Mineral Density (BMD) value was -3.0. This suggested to the doctor that the customer was “suffering” from severe osteoporosis. The doctor immediately wanted to prescribe some drugs to halt or reverse the progression of this “disease.”
Before downing dose after dose of a potent drug there are some important things to take into consideration. First, BMD is NOT the only risk factor associated with fractures. There are other factors and some of them are more important than BMD. One study actually suggests that BMD is the least of 6 risk factors.
Also, consider the potential side effects of the drugs being prescribed. Here’s a list of the published side effects of one prescription osteoporosis drug, Fosamax:
- allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
- difficulty or pain when swallowing;
- chest pain;
- pain or burning under the ribs or in the back;
- or new or worsening heartburn.
Other, less serious side effects may be more likely to occur;
- abdominal discomfort;
- stomach upset,
- diarrhea, or constipation;
- muscle, bone, or joint soreness or aches;
- eye pain; a rash;
- or an altered sense of taste.
It is important to understand the seriousness of hip fractures. In elderly women, approximately 24% do not survive a year and only 15% are able to walk across the room unassisted. A drug might help but there are other, less toxic and more useful things to consider.
The World Health Organization (WHO) established definitions of osteopenia and osteoporosis in 1993. Before then few people knew much about the “disease.” Osteoporosis is DEFINED as a “T” score of -2.5 or less. Osteopenia is a “T” score between -1.0 to -2.5. These scores are based on theASSUMPTION that the young skeleton is healthy and that as people age, their bones become progressively more diseased.
WHIO’s definitions transformed the majority of post menopausal women whose bones were aging normally into “patients” who have a “disease.” It turns out that the WHO study group that developed the criteria for diagnosing osteoporosis and osteopenia was funded by three drug companies. Funding itself does not automatically impugn the conclusions of the study group. But, the conclusions did happen to be in the drug companies’ interest. Shortly after the reports, drugs that had been in the pipeline were released for consumption.
There has NEVER been a randomized controlled study done to determine whether there is a benefit to screening women for osteoporosis with Bone Mineral Density tests. Nonetheless, the current recommendations call for women to have the test – even though there is no proof that the test offers a health benefit.
Is Bone Mineral Density the ONLY Risk Factor for Fracture? No. A study conducted in the Netherlands (note that many US doctors would not be willing to accept a foreign study) found that in women between the ages of 60 and 80, only one-sixth of their risk of hip fracture is identified by Bone Mineral Density testing. Other factors were just as important: increased frailty, muscle weakness, the side effects of other drugs, declining vision, and cigarette smoking.
Hip fractures are a serious situation, but Dr. John Abramson writes, “Proper exercise and good nutrition are important through all stages of life to build and maintain strong bones.”
The NIH studied almost 10,000 independently living women aged 65 and older. Over 7 years, women who exercised moderately had 36% fewer hip fractures. That is a statistically significant difference. This works out to at least TWICE the reduction observed in women who used a bisphosphonate drug (such as Fosamax). Moderate exercise is recognized as moderate-to-vigorous exercise for 2 hours a week.
In summary, If there is a difference in hip fractures when people use Fosamax, it is 0.3%, not the 56% that the drug companies report. They’ve manipulated the numbers to favor their drug.
These are important facts to consider when someone (often a doctor) uses only BMD test scores to instill fear into a person. Yes, hip fractures are serious. Women who experience them have a high risk of not surviving a year after the fracture – 24% will die in under a year and only 15% are able to walk unaided six months later.
Women (and men, to a lesser extent) should be concerned about prevention. It seems that prevention is related far more to other factors than to the use of a drug. I am not suggesting that any person refuse to take a prescribed drug based solely on these comments. However, before blindly accepting a prescription, talk seriously to the doctor about the real risk of fractures as related to the potential benefits and side effects from the drugs.