A Drug Company in Search of a Disease

Here's an article every woman should read: How a Bone Disease Grew to Fit a Prescription, by Alix Spiegel on NPR. It will make you rethink everything you thought you knew about osteoporosis, osteopenia and the drugs, like Merck's bestselling Fosamax, that treat low bone density.

I heard about this excellent piece of journalism from Susan Perry's Second Opinion column on MinnPost. As Susan puts it, "Warning: The story may make you want to strike an arm or leg (with one of those bones you’ve been told is worrisomely thinning) against a hard surface."

In summary, while osteoporosis is a real threat to older women, osteopenia was defined in the 1990s as a term for use by researchers, not as a condition to be treated. When Merck put Fosamax on the market, no one bought it. So Merck pushed (through a variety of methods, described in the NPR story) to get asymptomatic middle-aged women to have bone scans.



And what turns up on those scans? A whole lot of women who have "osteopenia." When you see that your bone density falls within that yellow area, you think, I don't want it to drop into the pink zone! What can I do about it? Well, there's this expensive drug you can take for the rest of your life...

The 57-year-old woman featured in the NPR story did just that, and she gives anecdotal evidence that her experience is common: "For example, she works in an office in Richmond, Va., with seven other women. 'Half the staff is younger, in their 20s and 30s, and then there are four of us that are over 50. Three of those four are on some kind of medication for osteopenia."

Like her, I had a bone scan a few years ago and came out within the yellow area. I've been taking Fosamax ever since. (Although maybe not for long after reading this!) How about you?

MinnPost's Perry also linked to the National Women's Health Network, which for years raised the issue of osteoporosis, but now takes the position that diagnoses of osteopenia are overblown, and that the long-term side-effects of Fosamax and its cohort are completely unresearched.

As NPR's Spiegel put in her story, "There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50s and continue treatment long-term in the hopes of preventing old-age fractures And none are planned."

And Fosamax, though it does definitely prevent bone loss, may not even have the effect everyone assumed it would have. According to NPR,

But, increasingly, bone scientists like Cummings say Fosamax — and drugs like it — are not a necessarily a win for most women with osteopenia.

Studies in women with osteopenia show that while Fosamax and similar drugs reduce spinal fractures, the drugs may not reduce other types of bone fractures that are more common in women who have osteopenia, say Cummings and Susan Ott, an associate professor in the department of medicine at the University of Washington.

"There was no difference in the number of [nonspine] fractures you had, whether you took the medicine or a placebo," says Ott. "It does make your bone density go up higher, but the number of fractures is what really matters, and that didn't really change."

I'll definitely be talking with my doctor.