Some allege that osteopenia is an artifical illness manufactured by the pharmaceutical companies to sell drugs. Some would even argue that osteoporosis itself is not a disease, but a risk factor for problems like bone fracture. Is a hidden disease even a disease? This is a minority position, however, as the symptoms of height loss and elevated risk of bad events lead most doctors to consider osteoporosis a real disease worthy of treatment.
However, with growing evidence that long-term bisphosphonate use is not as safe and beneficial as once thought, there is a move to limit use of this most widely used class of drug. The consensus is that bisphosphonates are generally safe, but the efficacy of continued use after 5 years is low because the medicine builds up in the bone and does not need constant replenishment.
Some would say the pharmaceutical companies and the medical industry has hyped low bone density beyond its importance and risk. The illusion is that the all women are at risk of suffering fragile bones and painful hip fractures. An analogy would be the medicalization of menopause which has provoked a backlash as we saw the rise and fall of estrogen supplements.
There is not much convincing evidence that osteopenia patients benefit from bone-building medications. Here is an NPR story on allegations of osteopenia disease mongering. The British Medical Journal published an analysis on this question in 2008. Text here.
Consumer Reports lists a prescriptions for osteopenia as one of several areas where patients should question doctors.
The website www.thnnt.com, which advocates evidence-based medicine, focuses on NNT - number needed to treat - to evaluate medical interventions. This site lists bisphosphonate treatment for post-menopausal women with a history of bone fracture as beneficial with a NNT (to prevent bone fracture) of 100. By contrast, the NNT for pre-menopausal women with no history was listed as No benefit found.
There have also been allegations of the "Over Calcification of America" and the population taking calcium supplements they don't need to take.
Bone Density Measurement
Some have questioned the value of DEXA scans because of how inaccurate they can be. The accuracy of the scan results can be off by 20-50% according to some experts. A Veterans Health Administration study found that for a group of patients tested with different scanners, the results ranged from 6% to 15%. This suggests the results of the scans are unreliable and undermines the confidence of diagnosis of osteoporosis and osteopenia and the subsequent administration of medication.
Last updated: Aug 25, 2012