By Norsigian and Stephenson
Wednesday, May 23, 2007
Osteoporosis Awareness and Prevention Month opened with a news splash about a new treatment for the bone-weakening disease. Judy Norsigian and Heather Stephenson suggest not rushing to get your bone density tested until you've weighed all the issues.
(WOMENSENEWS)--Earlier this month, headlines across the nation touted a new, simpler treatment for osteoporosis.
The once-a-year, injectable medication was said to reduce the hassles and health problems associated with current oral drugs.
The news may have left you wondering whether you should rush out and get your bone density tested to see if you need the new drug. Such a step might seem sensible, particularly if you are in or approaching menopause. But stop to think before you jump on this pharmaceutical-powered bandwagon.
The research on this drug, which is not yet approved by the U.S. Food and Drug Administration for treating osteoporosis, was sponsored by Novartis, the company based in Basel, Switzerland, that manufactures it. Like other pharmaceutical companies that underwrite research on their products, Novartis has every reason to publicize the benefits of the treatment and keep quiet about possible negative effects.
The new drug's promotion kicked off National Osteoporosis Awareness and Prevention Month.
Osteoporosis, the weakening of bones that increases fractures, is a serious public health concern as our nation ages. About 1.2 million osteoporotic fractures occur annually, with an estimated treatment and prevention price tag of $10 billion.
Osteoporosis is a particular concern for women, who make up 80 percent of all people with the condition in the United States. That translates to 8 million women.
But even as we learn more about this serious health problem and new medical discoveries that may address it, we need to be cautious about exposing ourselves to unnecessary tests and treatments.
Well-founded concern about osteoporosis should not lead editors, reporters and doctors to wave new treatments through to the public without any caveats.
Here are a few tips to help you navigate the hype and still protect your health.
If you are under 30 years old, you can still make your bones stronger and denser. If you're over 30, you can prevent or slow bone loss as you age. In either case eating a balanced diet that includes enough calcium and vitamin D and participating regularly in weight-bearing exercise such as walking, running, dancing or playing tennis will help protect your bones.
If you smoke, one of the best things you can do for your health is quit; smoking increases the risk of osteoporosis and bone fractures in addition to its other significant harms. You can also protect your bones by avoiding drinking excessive alcohol (more than two or three drinks per day), which can interfere with the balance of calcium and vitamin D in your body and affect other factors that increase bone problems.
Osteoporosis is just one risk factor for breaking bones. Others include your age, your weight, the medications you take, whether you smoke, and your individual and family history of fractures. It is fractures--particularly serious ones such as hip fractures that can trigger extended time in bed, overall health decline and premature death--that we want to avoid as we grow older.
Decreasing your risk of falling cuts your chances of serious fractures. Nine out of 10 hip fractures in older Americans are the result of a fall. To reduce your risk of falling, have your vision and medications checked (particularly if you take glucocorticoids, some anticonvulsants or tranquilizers) and clear your environment of hazards, such as scatter rugs. Strength training and balance exercises may also reduce falls.
If you're thinking about getting your bone density measured, don't start too soon. Health care providers who follow the best available clinical evidence recommend bone density testing only at age 65 or older, unless you have specific risk factors.
If you have your bone density measured and you are told you have "osteopenia," be cautious. This label means your bone mineral density is less than the average for young adult white women. Some women whose screening results put them in this category decide to take medication to ward off osteoporosis. But not all women who have osteopenia will develop osteoporosis.
In addition, for women with a "-1" or a "-2" screening result, there is no evidence of clear benefit from taking a bisphosphonate such as Fosamax and there is evidence of harm. Longer term use can in a small number of cases be associated with decay of the jaw, or "osteonecrosis."
Other medications have unclear benefits and definite harms.
Hormone therapy used to be a favored treatment and also a preventive measure for postmenopausal osteoporosis. But we now know that estrogen-progestin therapy increases the risk of breast cancer, stroke and blood clots for women of all ages, and dementia for women over 65. Estrogen-only therapy also increases the risk of blood clots and strokes, as well as dementia in women over 65. Therefore, hormone therapy is no longer recommended widely.
Other medications are now prescribed more often to treat postmenopausal osteoporosis. These include the bisphosphonates known as alendronate (brand name Fosamax), risedronate (Actonel) and ibandronate (Boniva); the hormone calcitonin (Miacalcin or Fortical); and a selective estrogen receptor modulator called raloxifene (Evista).
At its best, alendronate is reported to reduce the risk of hip fracture in a relatively small group of women: those with osteoporosis who are 68 years old, on average, and at high risk of hip fracture. Only 5 in every 1,000 women in this group will have a hip fracture in a given year without taking alendronate. Taking alendronate reduces their risk by 56 percent to 2 in every 1,000.
This benefit must be weighed against the known harm, which is an increased likelihood of the rare but serious complication of jaw crumbling. The other drugs in this class, risedronate and ibandronate, are associated with the same harm.
Raloxifene increases bone mineral density. However, it has been proven to reduce only vertebral fractures, not hip fractures, and it involves risks not found in non-hormonal drugs, such as increased likelihood of blood clots, hot flashes, nausea and leg cramps. Calcitonin also has not been shown to reduce non-vertebral fractures and may cause nausea, allergic reaction and dangerously high levels of calcium.
As you hear about new treatments for osteoporosis, question the sources of the information you receive. They may have ties to corporate interests that stand to gain by increasing women's fears of illness and disease. For example, the National Osteoporosis Foundation, which is the prime promoter of National Osteoporosis Awareness and Prevention Month, has received funding from Merck, the Whitehouse Station, N.J., pharmaceutical giant that markets Fosamax.
Such conflicts of interest make it harder to find trustworthy information about bone health.
In this month of increased awareness, women need to look beyond the announcements of new drug studies to sources of information that are free of ties to the pharmaceutical industry. The goal of better women's health should not be clouded by efforts to sell more tests and treatments and net bigger corporate profits.
Judy Norsigian is the executive director of Our Bodies Ourselves, a nonprofit women's health advocacy organization. Heather Stephenson is the editor of "Our Bodies, Ourselves: Menopause" (Simon and Schuster, 2006), which devotes an entire chapter to bone health.
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Our Bodies Ourselves:
National Women's Health Network
"When, How, and Which One? Navigating the Maze of Osteoporosis Drugs":
Osteoporosis and Bone Physiology:
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