Will bone density tests and and bone-mass increasing drugs Fosamax and Alendro reduce the risk of fracture in the elderly or are we ignoring the simple preventative steps we all must take as we grow older? Such steps includes partaking in fall prevention programs, taking people off inappropriate medications and making sure failing eye sight is supported.
I pose this question in light of the Prime Minister’s announcement this week that Medicare will be extended to cover bone density tests for people with osteoporosis aged 70 and over, and that the bone-mass increasing drugs Fosamax and Alendro will be subsidised by the Pharmaceutical scheme.
But just how real is this risk of osteoporosis and fracture?
If we are to submit the public purse to more expense, we must be clear about the risks involved.
The National Osteoporosis Foundation defines osteoporosis as a disease in which bones become fragile and more likely to break.1 However few people had even heard of osteoporosis before the 1990’s. Dr Bruce Ettinger, Associate Clinical Professor of Medicine at the University of California and an endocrinologist, says that the osteoporosis that causes pain and disability is a very rare disease. Only 5% to 7% of 70- year-olds will show vertebral collapse; only half of these will have two involved vertebrae; and perhaps one-fifth or one-sixth will have symptoms. 2.
One needs to now ask how and when the current problem of osteoporosis was invented.
Health researcher Sherrill Sellman writes:
Osteoporosis is big news-and big business-these days. As a disease, it emerged out of obscurity only two decades ago to become a concern for women throughout the industrialised world. Advertising campaigns in the media and fact sheets in doctors' waiting rooms and pharmacies continually warn women of the dangers of disappearing bone mass.2 Osteoporosis was intentionally exploited by the drug companies in the mid-1970's as compelling reason for women to take HRT. Up until that time, osteoporosis was a relatively unknown condition by the public. 3
Up and until 2002 women took HRT for impending bone loss believing the hype that One woman in two over the age of 60 is likely to crumble from an osteoporotic fracture.4
In the year 2002, the Women’s Health Initiative study found that taking HRT meant a pathetic 0.4 % reduction in fracture risk. With HRT failing the panacea test and with the knowledge that it had other serious side effects, Merck’s wonder drug, Fosamax became the heir apparent in the campaign to fight the ‘horrible’ scourge of osteoporosis.
We need to ask just what does our Prime Minister mean when he refers to osteoporosis as a ‘terrible disease.”
Has he been tricked into believing that this is anything but a very rare disease? It is time we all stopped being taken in so easily by clever and unethical marketing of useless and expensive tests and dangerous drugs.
Ray Moynihan and Alan Cassels question the value of the bone density tests and the drugs which have only minimal benefits but have serious side effects such as severe damage to the oesophagus and stomach.5
Bone density loss happens to us all as we age and can increase our chance of falls and fracture but so can other factors such as poor balance and muscular weakness as well as poor eyesight. Public awareness programs with regard to falls prevention take a second place to the money made available for drug treatments.
As to the value of the bone density tests themselves we should be aware that just before the launch of the osteoporosis drug Fosamax, the World Health Organisation defined a normal bone density as that which applied to young women of around the age of 30.
Such a definition is bound to render most older women as having bone density loss and the inevitable osteoporotic fracture. No wonder the current figures are that nearly 2 million Australians have osteoporosis .6
Professor David Henry from the University of NSW sees the situation as one in which osteoporosis is understood as a disease that needs treatment as opposed to the reality which is that fractures are a public health problem which need to be addressed by lifestyle changes and that the current hype is disease-mongering.7
In 2004 the Canadian Guidelines on osteoporosis concluded that there is no direct evidence that bone density screening reduces fractures. Yet over here in Australia we have our prime Minister announcing that Medicare will be extended to cover bone density tests for people with the disease aged 70 and over.
So what can be said about the drug Fosamax which is one of the drugs that are to be added to the Pharmaceutical Benefits. Government run trials of Fosamax among healthy women have shown that long- term benefits of the drug therapy are extremely small in reducing hip fractures.
How is it that we the general public have access to these startling research findings which prove the ineffectiveness of both the bone density tests and the drug therapies and yet the government doesn’t or if it does, takes no notice and announces that it will spend $225 million to “tackle the scourge of osteoporosis.”
It is time we all had a good look at how in the words of Ray Moynihan and Alan Cassels “ Drug companies are turning us all into patients.”
5. Ray Moynihan and Alan Cassels “The Selling of Sickness” How Drug companies are turning us all into patients. Alan and Unwin. NSW. 2005
7. Ray Moynihan and Alan Cassels “The Selling of Sickness” How Drug companies are turning us all into patients. Alan and Unwin. NSW. 2005homepage