Osteopenia Treatment – Not Worth The Risk and Expense?

PJ Hamel Health Guide
  • Have you been diagnosed with osteopenia?

    If so, you may very well be taking drugs to head off what you believe is the inexorable slide into osteoporosis. Maybe you’re on Boniva, or Fosamax, or Actonel to keep that T-score from dropping.

    After all, by preventing further bone loss, you’re protecting yourself from a broken hip and painful spinal fractures, right?

    Well, maybe. But a study published last year concludes that statistically speaking, 270 women diagnosed with osteopenia, would need to take an osteoporosis drug for 3 years in order for one of them to avoid a single vertebral fracture.

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    That means 99.996% of women taking drugs for osteopenia are potentially receiving no benefit.

    Now, this is beginning to sound a bit like the mammogram debate. The one that, according to statistical models in place just prior to the recently released new screening guidelines, goes something like this: 

    In order to prevent one woman from dying of breast cancer, 1,000 women must receive annual screening mammograms for 10 years. During that time, up to half of those women will have a “false alarm” – a mammogram callback, or additional ultrasound – and about 250 of the women will undergo a biopsy.

    All to save the life of a single woman.

    Are all those mammograms worth it?

    Depends whether you’re that one woman, I guess.

    I happen to be a woman whose life may have been saved by a mammogram. Since a mammogram caught my breast cancer before it had metastasized, I was able to receive treatment that gives me about an 84% chance of NOT dying of breast cancer.

    Still, put in statistical terms, the scale doesn’t really balance. 999 women having yearly mammograms for 10 years to save… me.

    And it seems to make even less sense when you’re talking about treating osteopenia; a vertebral fracture, though painful, doesn’t usually result in death. In fact, up to two-thirds of vertebral fractures are asymptomatic – that is, you don’t even realize you have them, and they don’t affect your quality of life.

    Are the expense, aggravation, and nasty side effects – some downright dangerous – of 271 women taking three years’ worth of bisphosphonates really worth saving one woman from a vertebral fracture?

    Are we as a society over-treating osteopenia?

    The introduction by W.H.O. (the World Health Organization) of an online tool designed to allow people to gauge their risk of fracture, and thus guide their decision to seek drug therapy, has recently highlighted this issue. FRAX is a simple, 12-question online survey that calculates your risk for a bone density-related fracture over the next 10 years.

    But many doctors are questioning the tool’s accuracy, given that it’s so simple. FRAX doesn’t take into account physical activity; the use of certain drugs than can affect bone mineral density; and vitamin D levels, all of which can raise or lower your risk of fracture. The mathematical formula used in the tool is also in question; officials at W.H.O. won’t reveal their specific formula.

  • With the proliferation of portable screening devices – at health fairs, in drugstores, perhaps even in a public event at your town hall – more and more people are finding it easy to get a quick read on their bone density. The problem is, what’s been established as osteopenia may simply be natural aging, and nothing to worry about.

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    In 1992, the W.H.O. defined osteopenia as bone density that’s “one standard deviation below that of an average 30-year-old white woman.” As doctors have since pointed out, a 65-year-old woman is different in many ways than a 30-year-old; because her hair is gray, her face is lined, and she doesn’t walk as fast as she used to – does that mean she needs drugs?

    According to current standards, potentially half of postmenopausal women worldwide have osteopenia. Should they all be taking Fosamax?

    Seems silly, doesn’t it?

    Perhaps it’s time for the medical community and the public to get together and reexamine this relatively new “disease.” It may just be that osteopenia is a natural part of the aging process and, given the risk/benefit equation,  simply not worth treating.

Published On: November 24, 2009