Perpetuating the Hype: The U.S. Surgeon General Report on Osteoporosis

The October report released with great fanfare and media attention has created a new wave of fear among populations of well men and women. But claims that by the year 2020 half of all American citizens older than 50 will suffer osteoporosis-related fractures are unsubstantiated, and alarming hip fracture mortality rates misleading. When osteoporosis is characterised by fragile bones that break easily it is linked most often to serious chronic conditions afflicting a small percentage of the population. A close examination of the evidence reveals that the great majority of the population need not be concerned about the disease. In fact for most people a good diet, healthy lifestyle and regular exercise are sufficient protection against future fracture. In the words of Californian Osteoporosis expert Dr Bruce Ettinger, “the osteoporosis that causes pain and disability is a very rare disease”.

The Surgeon General's clarion call that there are 34 million cases of the osteoporosis 'precursor' osteopenia (low bone density) in the US is meaningless. When osteoporosis is defined in terms of low bone density then it is going to apply to the majority of the population as everyone loses bone density as they age. Whether this translates into weaker bones that fracture more easily is really the question and the evidence just does not support it. In fact, people with higher bone density go on to have the majority of fractures! Most fractures including hip fractures are due to complicating factors other than low bone density.

Drugs and products that influence bone density loss in ageing adults are widely prescribed but the evidence that they will actually prevent fractures is minimal. Bisphosphonates, the osteoporosis ‘preventing' drugs like Fosamax and Actonel are unpleasant to take and so ineffective that large numbers of people with low bone density need to be treated in order to benefit just one or two. Whether the drugs are safe long term is still not confirmed. There are concerns that long term use may lead to bones that are more brittle and prone to microfracture. Despite this, worldwide sales of Fosamax went from US$1 billion in 2000 to $2.7 billion in 2003, probably because all those women who were taking HRT for their bones have been prescribed Fosamax or Actonel instead.

In the vast majority of cases, having a bone density test or taking a drug will not prevent fragile bones later in life. Hip fractures can be reduced by preventing falls in the elderly through safer environments, exercise programmes and attention to overall health.

For references and more information go to Osteoporosis: Blowing the Whistle on the Epidemic or read my book The Myth of Osteoporosis .

Thanks to all of you who have been visiting the website and offering feedback. Spring is here in New Zealand so we are looking forward to balmy days ahead while those of you in northern climes are bracing for colder days. Take care.

Warmest wishes

Gill Sanson