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Definition is a bone of contention

By Laura Stephenson Carter

Millions more women could be needlessly treated for osteoporosis under new guidelines recommended by the National Osteoporosis Foundation (NOF) and the American College of Obstetricians and Gynecologists (ACOG). ADMS study in the journal Health Affairs suggests that the new disease-definition guidelines would come at a net cost of $46 billion.

Osteoporosis makes bones more fragile and likely to break. It affects 44 million Americans, 68% of whom are women. One in two women and one in four men will have an osteoporosis-related fracture during their lifetimes. DMS internist Brooke Herndon, M.D., who led the study, agrees that osteoporosis is a major health concern, especially for postmenopausal women. But she says there's no evidence that treating more women will reduce the number of fractures.

Eligible: Under current guidelines, established by theWorld Health Organization, 6.4 million women aged 65 years and older and 1.6 million women aged 50 to 64 are eligible for drug therapy. Under the new guidelines, the number of treatment-eligible women would jump to 10.8 million in the 65-plus group and 4.0 million in the younger group.

"Expanding disease definitions . . . always means that the number of affected people rises," wrote the DMS authors (who are all members of the VA Outcomes Group in White River Junction, Vt.). "But this group of newly identified patients is at lower risk." "There's a lot of confusion in clinic, because almost every woman over the age of 50 has low bone density," says Herndon. "What's so low that you should do something about it? What level of ‘low' actually matters to the patient?"

The authors pointed out that expanded disease definitions can mean larger markets for pharmaceutical firms and that WHO, NOF, and ACOG all receive funding from the drug industry. They would like to see an "independent organization, such as the Institute of Medicine, review the evidence and develop an unconflicted definition of osteoporosis requiring treatment."

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