Study - Treatment should begin before full-blown osteoporosis
Tuesday, May 25, 2004
CHICAGO -- A study suggests some women might benefit from taking bone-boosting drugs earlier than many doctors recommend, because they can break bones well before they develop full-fledged osteoporosis.
The study involved 149,524 white postmenopausal women, age 65 on average, who had bone density scans. Of the 2,259 who broke bones during the following year, 82 percent had initial bone-density scores indicating thinning bones but not osteoporosis.
Only 18 percent of women with fractures had scores at or above the threshold many doctors use to define osteoporosis and to prescribe drugs.
The study was led by Dr. Ethel Siris at Columbia-Presbyterian Medical Center and included researchers from Merck & Co., which makes the osteoporosis drug Fosamax and funded the study. A Merck doctor participated in a committee that oversaw the study design and analysis, Siris said.
Experts not involved in the study said the data appear sound.
The researchers suggested doctors consider lowering the threshold for prescribing osteoporosis drugs, especially for women who have certain risk factors that increase their chances of breaking a bone.
"My goal is not to sell medicine; my goal is to inform the debate," Siris said.
The research appears in Monday's Archives of Internal Medicine.
Dr. Leonard Serebro of Ochsner Clinic Foundation cautioned that while drug treatment can help prevent fractures in women with full-blown disease, more evidence is needed to show the same benefit in women with milder bone loss.
An estimated 10 million Americans, mostly women, have osteoporosis, and some 34 million have low bone density and are at risk of developing the disease, too. Women's risk of developing osteoporosis increases as they enter menopause and lose the bone-protecting effects of estrogen.
The National Osteoporosis Foundation recommends bone density screening for all women 65 and older and for younger postmenopausal women with at least one other osteoporosis risk factor, including smoking, low weight and family history of hip fracture.
Many doctors fail to screen women. And when doctors do the tests, they often do not prescribe medicine unless the results indicate full-blown osteoporosis -- a bone-density score of minus 2.5 or less, the researchers said.
They said a more reasonable approach would be using National Osteoporosis Foundation guidelines recommending that medication be considered for women with scores of minus 2 or less; or minus 1.5 or less for those with at least one risk factor.
However, bone-building medication costs around $70 monthly and some insurers will not cover it if women do not have full-blown osteoporosis, Serebro said.
On the Net:
National Osteoporosis Foundation: http://www.nof.org