OSTEOPOROSIS
Blowing the whistle on the epidemic
by Gill Sanson
www.bonestory.com

Chances are, if you are female, Caucasian, and of menopausal age you have been convinced that you are at risk of suffering an osteoporotic fracture - perhaps of the spine, probably of the hip, possibly fatally, unless you avail yourself of the technology and the medication that will diagnose, treat, and 'cure' you.

Twenty years ago most people had never heard of osteoporosis, and doctors reported that they saw few patients with the condition. Fracturing of hips or compressing of vertebrae resulting in painful curvature of the spine were unusual and confined to the very elderly. Now we are warned of an epidemic. One in two Western women are predicted to fracture as a result of osteoporosis, and a 50 percent increase in the next 15 years is expected to encompass Asia, Africa and South America - countries which currently have the lowest rates of fracture in the world.

Facts like these suggest that osteoporosis is more widespread than breast cancer, heart disease and AIDS combined. How did this happen and more importantly, is it true? And where are all these people? Surely our hospital beds should be full of people with fractures, and most elderly women should have severely curved spines ('dowager's humps)?

MISLEADING ADVERTISING
An extensive review of the osteoporosis literature reveals that the information in patient brochures, advertising and the media is misleading, often inaccurate, and has been allowed to proliferate without public policy and objective analysis. Despite contradictory challenging evidence being published repeatedly in prestigious medical journals, the front-line promoters of the osteoporosis industry present a convincing and unequivocal message to doctors and their patients: osteoporosis has reached epidemic proportions, and immediate intervention by way of regular diagnostic screening and pharmaceutical treatment is recommended.

POWERFUL MARKET FORCES
Predicting a global epidemic is providing unlimited commercial return for the 'osteoporosis-preventing' pharmaceutical, bone testing, dairy and calcium industries which have emerged with lightning speed in recent years. The immense profit for these companies stands to further increase as more and more of the graying female baby boom population simply by virtue of their age, acquire a 'risk factor' for osteoporosis.

Many international experts admit that opinions about osteoporosis tend to be determined by the pharmaceutical or bone densitometry company that is being represented. Dr Mark Helfand, one of the members of the US National Institutes of Health consensus panel that spent three days in March 2000 conferring about the prevention, diagnosis and treatment of osteoporosis, had this to say in a recent Washington Post article: "I think even people who agree that osteoporosis is a serious health problem can still say it is being hyped. It is hyped. Most of what you could do to prevent osteoporosis later in life has nothing to with getting a test or taking a drug."

THE MARKETING OF FEAR
The reality is that osteoporosis is being diagnosed as a disease when in most cases it isn't. Osteoporosis is a very serious disease with potentially devastating consequences for the genuine sufferer. But frightening images, wildly exaggerated statistics, and inaccurate diagnoses are steering healthy women in their 50s and 60s into long-term dangerous treatments for a disease that most of them do not have.

In the early 1980s osteoporosis was a relatively rare disease, affecting women and men alike. In 1982 a major promotional campaign sponsored by Ayerst (now Wyeth Ayerst) pharmaceuticals, the world's biggest producer of hormone replacement therapy (Premarin), hurtled osteoporosis into position as a major women's health issue. By the mid-1980s most women had not only heard of the disease, they had accepted and were increasingly fearful of the apparent inevitability of hip fractures and a life of disability and dependency.

A RISK FACTOR BECOMES THE DISEASE
In 1994, in the wake of the globally successful marketing campaign, came a new definition of osteoporosis so broad it would catch half the postmenopausal women alive. It would also cement-in the economic futures of the 'osteoporosis-preventing' industries. Previously diagnosed as a condition of fragile bones following a low impact fracture, the new diagnosis of low bone density alone, coincided with the availability of dual energy x-ray absorptiometry (DEXA) - technology that could measure the mineral content of bone. The supposedly neutral World Health Organisation group that met to re-define osteoporosis at this time was funded by three major drug companies that stood to gain from the new definition.

Extensive reviews of the evidence in the US, Canada, Sweden, Australia and the UK all conclude that bone density testing does not accurately identify individuals who will go on to fracture. Bone mineral content relates to the quantity not the quality of bone. It reveals nothing about the strength, micro-architecture, turnover, size or shape of bone - all factors which contribute to fragility. Despite this, low bone density remains the default definition of the disease, making osteoporosis one of the most commercially profitable diseases ever because it targets, diagnoses and treats the well. Everybody loses bone density as they age, but because the current definition measures a woman's bone density against that of a hypothetical healthy young woman aged 20-35, more than half the postmenopausal population of Western women can now find themselves diagnosed with the disease.

DANGEROUS TREATMENTS
The fact that drugs to slow bone density loss (mainly hormone replacement therapy (HRT), bisphosphonates and SERMS) are dangerous and have minimal anti-fracture evidence to justify their use is overlooked. Most doctors appear unaware that the Food and Drug Authority in the US has recently withdrawn its approval of HRT as a treatment for osteoporosis. Prescribing continues unabated, and HRT is now the number one prescription drug in the world, despite evidence that its benefit is limited to the relief of hot flushes and vaginal atrophy only, and despite alarming new evidence of an increased risk for heart attack, stroke, clotting, breast and ovarian cancer with short and long term use.

Bisphosphonates are relatively new bone-sparing drugs and sales of Fosamax produced by the pharmaceutical company Merck have skyrocketed in the last 5 years; in 1999 they reached US$1 billion and by 2000 they had reached $1.3 billion. Claims that Fosamax significantly reduces fracture rates in women with low bone density are grossly misleading and concerns are now raised that using the drug for more than five years may produce an older skeleton with more crystallised bone which fractures more easily.

SERMS (selective estrogen receptor modulators) such as Raloxifene (or Evista), the latest in the anti-osteoporosis treatment arsenal, are marketed widely as a treatment option that shows great promise. But the advertising fails to impress that they can increase menopausal symptoms by 50 percent and increase the risk for the potentially fatal conditions deep vein thrombosis and pulmonary embolism.

THE CALCIUM DAIRY MYTH
The role of calcium in preventing osteoporosis is overstated. Calcium supplementation alone does not appear to prevent fractures, and too much can be harmful. A diet covering the diverse nutritional needs of bone including calcium, vitamin D, magnesium, vitamin K, boron, manganese, zinc, copper, silicon and others essential nutrients is more appropriate than supplementing with large amounts of calcium.

The claims of the dairy industry that milk consumption builds strong bones and prevents osteoporosis are misleading and do not have the evidence to support them. A review of 57 studies published in the American Journal of Clinical Nutrition in 2000 examining the evidence for dairy food and bone health concludes "...the body of scientific evidence appears inadequate to support a recommendation for daily intake of dairy foods to promote bone health in the general US population."

OSTEOPOROSIS IS RARE IN HEALTHY INDIVIDUALS
Osteoporosis as defined by fragility fractures is uncommon, even rare in women under 80 years, and the vast majority of the population never fracture as a result of low bone density. Fractures are likely to occur in the presence of other factors involving illness and frailty such as immobility, dementia, medications (such as corticosteroids), thyroid conditions and hazardous home environments. The older a person is, and the more unwell they are, the greater the risk of falling and breaking a hip. By maintaining a good level of health and fitness, a well woman in her 50s and 60s is doing everything she can do to avert such an event.

Exercise and a nutrient-rich diet are the most effective strategies to avoid osteoporosis. The force of muscles pulling against bone stimulates bone remodelling and bone formation. Limiting heavy protein and sodium intake, reducing alcohol and not smoking are also fundamental to maintaining strong bones.

STAY INFORMED!
There is a worrying lack of readily available information that is not commercially motivated. The rush to provide costly and risky medical solutions for low bone density in healthy postmenopausal women is drawing attention away from the very important issues of preventing falls in the elderly, diagnosing genuine sufferers, and encouraging regular exercise and appropriate diet to maintain bone health.

It is essential that all of us are educated about the accuracy of diagnostic methods and the safety and effectiveness of any treatment before we embark upon it. The Osteoporosis 'Epidemic' - Well Women and the Marketing of Fear deals to the current information gap, and offers a hitherto unpublished perspective on the issues associated with osteoporosis. It provides essential evidence-based information from world experts and major medical journals; and positive direction for anyone who has been diagnosed with osteoporosis or believes they are at risk for fragility fracture.

The Osteoporosis 'Epidemic' - Well Women and the Marketing of Fear - Gill Sanson (Penguin Books New Zealand, 2001) To purchase this book, contact info@bonestory.com, or visit the website at www.bonestory.com

CTM COMMENT: Gill Sanson's excellent book is sure to put a lot of minds to rest over the medical terror campaign that has been 'osteoporosis'. If you are a drug company who has a 'cure', do you not have a vested interest in marketing 'the disease'? As the saying goes, "If you think you are well, you simply haven't had enough tests yet."

Good nutrition, clean water, and a healthy, skeptical eye on fraudulent and unethical practices in medicine and industry will be what you will need to navigate the stormy roads of life. Become an expert on your health. You are the most commercially unbiased arbiter of your own health and well-being there is.