Map of life expectancy at birth from Global Education Project.

Thursday, May 28, 2015

Another visit from Les Izmore

No doubt, if you should be among the minority of Americans who watch TV, you have seen those ads featuring famous cutie-pie older women who are totally thrilled with their osteoporosis pills. The whole reason doctors prescribe these at all is because drug companies sponsored a World Health Organization study group in 1994 that decided that  threshold score on a bone density test constituted the "disease" of osteoporosis and that people with this disease should take pills to increase their bone density, lest they suffer hip fractures.

Cometh now an international gaggle of scholars led by presumably not dour Finn Teppo Jarvinen to say hold on a minute. While having low bone density does increase the risk of hip fractures, most fractures occur in people who don't have low bone density. The proximate cause of hip fractures is falling, not low bone density. If you just depend on giving people pills, you would have to treat 175 women for three years to prevent one hip fracture. But .. .

It doesn't seem to help to treat for a longer time -- in fact if anything it might be harmful. We're spending $11 billion a year on these pills now and there also isn't any evidence that they are beneficial in women over 80. But . . .

We can make a huge difference without drugs. A meta-analysis finds that exercise training reduces the risk of hip fracture by 60 percent! And obviously it has many other benefits. Smoking cessation also is comparably useful. And . . .

Women diagnosed with osteoporosis are more likely to limit their activities to avoid falling. See above, that's exactly what you don't want to do. There are important side effects to the drugs as well, including weird femoral fractures and osteonecrosis of the jaw. The authors conclude,

The dominant approach to hip fracture prevention is neither viable as a public health strategy nor cost effective. Pharmacotherapy can achieve at best a marginal reduction in hip fractures at the cost of unnecessary psychological harms, serious medical adverse events, and forgone opportunities to have greater impacts on the health of older people. As such, it is an intellectual fallacy we will live to regret.
Well, maybe "we" will regret it, but not the drug company executives who are raking in the bucks.


robin andrea said...

I was diagnosed with osteoporosis a few months ago. The nurse practitioner highly recommended that I take one of the bisphosphonates currently being marketed. I said that I wouldn't, but that I would increase my vitamin d and do even more walking (2-4 miles a day). I have pretty low bone density in my hips and have been a bit more cautious when we walk so that I don't do something stupid, like fall. Three weeks ago, when walking out of a friend's house I took a pretty good fall, and all I could think was, "Hurray, I fell and didn't break anything." I plan to stay very careful. No falling.

kathy a. said...

My SIL has had 4 fractures in a bit over 2 years. She only recently turned 57, but her unusual dementia makes her unbalanced and more likely to fall -- and less likely to be cautious about her constant pacing. I'm glad nobody has recommended this kind of med, but dreading the day when it's a hip instead of an arm. Sigh.

Go, Robin!

Cervantes said...

Yes Robin, definitely keep walking! You could consider other activities as well that can help with balance, like tai chi or something. Not falling is the most important thing.