Controversy of Osteopenia

Several elements of Osteoporosis are held in question or thought of as controversial; such as the term osteopenia as well as the medications and their use.   

The definition of osteoporosis is porous bone, causing the bone to lose mass and its supporting structure. The shape of the bone may remain intact until a fracture occurs. A measurement of -2.5 or more, determined through bone mineral density testing, is considered to indicate sufficient bone lose to be called osteoporosis.  In 1992, the World Health Organization (WHO) set measurements of -1.0 to -2.5 to be osteopenic and -2.5 or more osteoporosis.  Physicians and drug companies have since used the designation osteopenia as a pathological condition of pre-osteoporosis and began treating it with the same medications used for the severe condition of osteoporosis. Originally, the term osteopenia was used to identify a group of people who were at high risk of bone fracture; only the emergence of a problem and not a pathological condition (What is osteopenia?, n.d.). 

Why is this controversial?  The designation of osteopenia was only to be used to point to a potential problem and not a pathological condition; however, became a diagnosable condition.  The new diagnosis was used for treatment purposes and has caused the number of women taking osteoporosis medications to increase substantially.  Osteoporosis went from a rare but serious condition to one that was affecting or potentially affecting millions of American women (Maxwell, 2011).  These women were then prescribed medications to slow or prevent bone loss; however, did all these women need to take medications? 

Pros and Cons

Cons: Medications such as Fosamax and Actonel were originally developed to be used for those diagnosed with osteoporosis (a severe condition) to reduce fracture risks. Some of the side effects of the medications are serious and do not necessarily show to be effective in bone loss management in those considered osteopenic (Murphy, 2009; Maxwell, 2011). These side effects were “heartburn, indigestion, nausea, inflammation of the esophagus and, in some cases, death of the jaw bone” and serious eye problems (Ramaley, 2008, para. 4; Murphy, 2009).  The side effects were thought to be acceptable to offset the high risk of fracture from osteoporosis.  For women diagnosed with osteopenia where the risk of fracture is lower, these medications may be more than is needed and may cause harm.  There are other means to control bone loss in those with a slightly lower bone mass with fewer side effects (i.e. exercise & diet and lifestyle changes).  A 2002 study to determine better guidelines for bone mineral testing and treatments by a federal committee chaired by Al Berg, M.D., head of the University of Washington's Department of Family Medicine, “concluded that testing should be targeted to women 65 or older and that DEXA testing should be limited to the hip” (Ramaley, 2008, para.7).  This supported the premise that women were being overly tested and medicated for this condition. 

Pros: Education on health conditions is the best way to prevent them.  Before 1974 only 23% of Americans had ever heard of Osteoporosis (Maxwell, 2011).  Many American women suffered from this debilitating condition without relief or forms of treatment.  Fracture rates were high in these older women.  These fractures were considered a normal part of aging.  With the WHO setting the standard for diagnosis and the drug companies’ modes of determining the severity of the condition and drugs for treatment, fractures and the condition of osteoporosis were recognized and reduced.  The thought of preventing bone loss in younger women (50 – 65 years old) thus, preventing or delaying the condition, was the rationale behind the designation of osteopenia. 

Recognizing that DEXA and the current standard deviations are not enough to properly diagnose fracture risk and osteoporosis; has pointed W.H.O. to develop other tools to consider lifestyle as well as pathological indicators.  The FRAX tool is an online program used to predict a 10 year probability of hip fracture using individual patient lifestyle indicators and testing data (Gavalas, 2011).  Although, this is not a foolproof tool it does use more than the bone mineral density score to predict fracture risks. Research continues to look at better ways to estimate fracture risks and diagnosis osteoporosis more accurately.

Controversy is a positive part of research. It is a motivator to continue to study and review conditions, treatments, and methods of determination of any new or current disease designation.

References

Gavalas, E. (2011).WHO controversial osteoporosis tool. Retrieved from http://blog.progressivehealth.com/who_controversial_osteoporosis_tool.html

Maxwell, C. (2011). Osteoporosis, osteopenia, and osteonecrosis. Ask Dr. Maxwell. Retrieved from http://askdrmaxwell.com/healthconcerns/osteo

Murphy, K. (2009). Splits form over how to address bone loss. New York Times. Health. September 7, 2009. Retrieved from http://www.nytimes.com/2009/09/08/health/08bone.html?_r=2&ref=health&

Ramaley, D. (2008). Osteoporosis: What you need to know. Seattle Natural Health. Retrieved from http://seattlenaturalhealth.com/osteoporosis.html

What is osteopenia? (n.d.).  Retrieved from http://www.news-medical.net/health/Osteopenia-What-is-Osteopenia.aspx

Personal Summary - Presentation

“Osteoporosis Treatments” - Personal Summary

One of my biggest difficulties in presenting, especially to a new group, is volume.  I tend to not project well.  I hear myself as being loud and tend to overcompensate, so I come across as soft spoken.  I know this of myself and have worked on it and have improved over the years but, I have a ways to go yet.

I should become familiar with the presentation equipment before the time of presentation. I felt like I stumbled and was a little disorganized.  I did not understand exactly how our presentations were to be done.  I figured mine was long and only part A would be allowed; however, I thought we would be presenting it fully and not in the time frame we did.   I anticipated having 30 minutes for the presentation but did not know of or account for the several minutes for “setting the stage”; which took from the presentation time.

Practice is everything and more is always better.  Knowing the time frame and format beforehand would be helpful for practicing a presentation like this. My primary presentation venue at work is in the classroom.  I am not accustomed to condensing my presentation materials for class presentations; therefore, attempting to condense and choose key points and stay on target for my goals and outcomes was challenging.

My video showed that I did not move around much nor did I over use my hand gestures.  To some this may have been perceived as a less energized presentation.  I did begin to move into the audience a little later in my presentation during the interactive section. Maybe rearranging my activities to be interspersed better could have helped this perception.  

I know I am my own worsen critic and will pick my performance apart, probably more so than anyone else.  But, I hope you gained some helpful information for this presentation.

Presentation Video

This is my presentation video. I have compressed it as small as I can and still have some viewing quality. Have patience as it is a large file. It may take a couple of minutes to load. You will have the option to open in windows media player.  Thanks for viewing.

video

New Drug for Osteoporosis

Medications for osteoporosis have changed in the last 15 years.  Women were started on Fosamax in pill form as the gold standard treatment. The pill was taken once a day with very specific instructions on when and how to take it.  This has changed over the years to a 5 day a week pill to a once a week pill. There are new drugs that can be used without the side effects you had with Fosamax or the demanding instructions on when and how it was taken. Fosamax was also restricted to women.  Reclast is the current medication prescribed. It can be used in men and women. It is an intravenous (IV) administered drug that is taken once a year. Administration is usually done in the doctor’s office and takes about 15 minutes.  

The newest addition to the drug arsenal is Prolia.  It is also administered in the doctors office but in a two shot a year dose. The side effects are not as distressing as those of Reclast (those of Reclast are few but can be severe). One in particular for Reclast is the necrosis (death) of the jawbone. The occurrence of this has been noted as low but does sometimes occur.

The Prolia is considered to have a less dramatic effect on the jawbone. One thing though, Prolia is considered a last resort treatment. In other words, if other treatments are working do not change to something new. Prolia is used only if nothing else slows bone loss or can not use these other drugs at all. Look at the brochure on Prolia to see if this is something you need to talk to your doctor about.

Amgen. (2012). Prolia – 2 shots a year brochure. Retrieved from http://www.proliahcp.com/patient-education/?WT.srch=1