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BONES AND JOINTS -
BONE MINERAL DENSITY

I’m writing to follow-up on your questions about osteoporosis and your Bone Mineral Density (BMD) results. The following is quoted and paraphrased from a book titled, "Overdosed America", by Dr. John Abramson, M.D.

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 the ASSUMPTION that the young skeleton is healthy and that as people age, their bones become progressively more diseased.

Is it NORMAL or is it a DISEASE?

WHO'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.

Without drugs like Fosamax® women with osteoporosis had a 99.5% chance of making it through the year WITHOUT a hip fracture. Adding Fosamax changed that figure to 99.8%. The overall improvement was from 0.5% risk to 0.2% risk. The difference between those two risk factors is calculated at 56%. The bottom line is that 81 women with osteoporosis have to take Fosamax for 4.2 years, at a cost of over $300,000, to prevent one hip fracture.

Is BMD the ONLY Risk Factor for Fracture?

A study conducted in the Netherlands (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 as the "T" scores:

  • increased frailty,

  • muscle weakness,

  • the side effects of other drugs,

  • declining vision

  • and cigarette smoking.

Bone Mineral Density testing is NOT the primary predictor of hip fracture.

Maybe Fosamax Isn't REALLY the answer

As 1998 study published in the New England Journal of Medicine looked at women with osteopenia who used Fosamax®. This study showed that the risk of hip fractures actually WENT UP 84%. This seems like a large percent increase but the number of hip fractures was so low that the difference did not reach statistical significance. Furthermore, the risk of wrist fracture INCREASED by about 50%. And this figure may be statistically significant.

Other Drug Treatments

You asked about Miacalcin. Dr. Abramson writes, "Miacalcin, administered by a nasal spray, has an inconsistent effect on hip fractures and vertebral fractures depending on the dose."

Hip fractures are a serious situation, but Dr. 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 Fosamax®. Moderate exercise is recognized as moderate-to-vigorous exercise for 2 hours a week.

There is a lot more but I wanted to hit the high points about using drugs to "treat" a "disease" that is based on a questionable (unproven) Bone Mineral Density test.

In summary, IF there is a difference in hip fractures when people use Fosamax® the difference 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 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 moths 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. I do suggest, however, that before blindly accepting a prescription, you talk seriously about the real risk of fractures as related to the potential benefits and side effects from the prescribed drugs.