Value of drugs for pre-osteoporosis exaggerated: Prevention or disease-mongering?

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Public release date: 17-Jan-2008

http://www.eurekalert.org/pub_releases/2008-01/bmj-vod011608.php

Contact: Emma Dickinson

edickinson@...

44-9

BMJ-British Medical Journal

Value of drugs for pre-osteoporosis exaggerated

Drugs for pre-osteoporosis: Prevention or disease-mongering?

A series of recent scientific publications have exaggerated the benefits

and underplayed the harms of drugs to treat pre-osteoporosis or

“osteopenia” potentially encouraging treatment in millions of low risk

women, warn experts in this week’s BMJ.

The authors believe that this represents a classic case of

disease-mongering: a risk factor being transformed into a medical

disease in order to sell tests and drugs to relatively healthy people.

Osteopenia or “pre-osteoporosis” is said to affect around half of all

older women and, in at least one country, drug companies have already

begun to market their drugs to women with osteopenia, based on

re-analyses of four osteoporosis drug trials.

But the authors of this week’s BMJ paper argue that this move raises

serious questions about the benefit-risk ratio for low risk individuals,

and about the costs of medicalising and potentially treating an enormous

group of healthy people.

These reanalyses tend to exaggerate the benefits of drug therapy, they

say. For example, the authors of one reanalysis cite a 75% relative risk

reduction, though this translates into only a 0.9% reduction in absolute

risk.

In other words, up to 270 women with pre-osteoporosis might need to be

treated with drugs for three years so that one of them could avoid a

single vertebral fracture.

Most of the reanalyses also play down the harms of drug therapy, they

add. For example, the reanalysis of data for the drug raloxifene focuses

solely on the potential benefits, with no mention of an increased risk

of blood clots.

Finally, like much of the published literature on osteoporosis, these

analyses have potential conflicts of interest, they write. For instance,

all of the original drug trials being re-analysed were funded by

industry and, in three out of four cases, drug company employees were

part of the team conducting the reanalyses.

The World Health Organisation is currently developing guidance on how to

deal with women categorised as having osteopenia. Whether this will stop

industry efforts to encourage treatment in low risk women is, however,

questionable, they say.

“We need to ask whether the coming wave of marketing targeting those

women with pre-osteoporosis will result in the sound effective

prevention of fractures or the unnecessary and wasteful treatment of

millions more healthy women,” they conclude.

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ne Holden, MS, RD < fivestar@... >

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