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