Osteoporosis Drugs: Good Medicine or Big Pharma Scam?

[HuckleB]

http://www.sciencebasedmedicine.org/?p=3278#more-3278

"A recent story on NPR accused the drug manufacturer Merck of inventing a disease, osteopenia, in order to sell its drug Fosamax. It showed how the definition of what constitutes a disease evolves, and the role that drug companies can play in that evolution.

...

When Merck started marketing Fosamax, not many women were being screened for osteoporosis because the standard DEXA (dual energy x-ray absorptiometry) test required expensive equipment and was not readily available. They thought if they could increase the rate of diagnosis they could sell more pills. Merck promoted the development of small, less expensive scanners that could be used on a heel or wrist in a doctor’s office. Merck even set up a nonprofit organization called the Bone Measurement Institute, which worked to spread the use of these machines and bring down the price of bone exams. Unfortunately, the results of those scans did not correlate well to the results of the gold standard DEXA scan.

...

The results of the scans promoted by Merck were reported either as normal bone density, osteopenia, or osteoporosis. Osteopenia carries only a small increased risk of fractures, but the assumption was that left untreated it would progress to osteoporosis. It is really more of a risk factor for osteoporosis than a disease in its own right. Some women diagnosed with osteopenia may not even have bone loss; they may just be at the low end of normal on a wide spectrum. But osteopenia sounds abnormal, and it sounds like a diagnosis, and it sounds to a lot of people like it needs treating. A new disease was born with a ready-made treatment.

...

Big Pharma advertises but it is doctors who write the prescriptions: when drugs are over-prescribed, only the prescribers are to blame. What should doctors do? In the first place, they should be recommending preventive lifestyle changes to all their patients. They should stick to the best science-based practices and evaluate the evidence for themselves rather than being influenced by Sally Field or by Big Pharma propaganda. They should prescribe drug treatments only when fracture risk is significant, when a fracture has already occurred, or when they think bone density is significantly low (still a judgment call). They should explain the gray areas to their patients and involve them in the decision to treat. They should think in terms of number needed to treat and number needed to harm. And they should be aware of the games Big Pharma plays."

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Why aren't the "Big Pharma Shills" defending Big Pharma to the bitter end?

Hmmmmmmmmmmmmmmm.

[SheilaT]

1. This is a good example

of how more and more conditions are being medicalized. That is, conditions that were considered more or less normal some years back, are now considered abnormal and in need of treatment, mainly some kind of medication.

Blood pressure that's only slightly elevated now requires medication. The normal bone thinning that comes with age requires medication. And so on.

I'm 61 years old, take no regular medication, not even vitamins, I try to eat sensibly, not drink too much, I don't smoke, and I'm the healthiest person I know. Coincidence?

[HuckleB]

7. What do you mean by "condition" and "medicalized?"

[Warpy]

21. Do you want to wait until someone fractures a hip

before they're diagnosed with osteoporosis and offered these drugs? Remember, hip fractures are 50% fatal within 6 months for people over 65, even with the best treatment available. It's a massive injury that can end life pretty effectively and miserably.

Isn't it better to protect high risk people with a biphosphonate pill once a week or once a month?

Think.

[Ian David]

2. ...

Bold font is cruise control for awesome!

[spartan61]

3. I broke four bones in less than two years and then, finally,

had a DEXA test. It showed that I had severe osteoporosis so I was put on Fosomax. Along with this I did weight bearing exercises and took lots of calcium with vitamin D. After 10 years, my latest DEXA shows great improvement. My doctor has taken me off Fosomax for a couple of years. Apparently the latest research shows that those of us on the medication need to take a "break" from it every few years. I wonder how Merch likes this latest research?

[stray cat]

4. Clearly you or a loved one is not suffering the effects of osteoporosis

try breaking bones in your feet constantly over two years - two years with never a moment when you were not trying to walk on broken bones

[HuckleB]

6. Did you read the article?

Your response makes me think that you didn't read it.

[busymom]

5. I'm on the fence.

There has been a tightening of controls on earlier stages of many diseases...though this is a benefit on one hand to the pharma companies, earlier treatment of some conditions can prevent late effects. I would much rather treat high blood pressure more aggressively, for example, than wait and have strokes or other problems down the road. The same goes for osteoporosis and diabetes.

[mopinko]

8. npr did not accuse anyone of anything.

they presented the facts of the situation. imho, they did color them somewhat, and the story did sound accusatory. but they did not come out and accuse anyone of anything.

i take these drugs, i am grateful for these drugs. i watched my mother disintegrate, losing her quality of life, and her mind. i also watched my sister at only 55 (my age now) take a small fall and spend a year trying to get her fractured radius to heal, infection and all. people who think this is about an occasional small fracture, and that it is the same as a kid who fell off a bike do not have a clue.
i have no intention of going down that path. i do do other things, since i am now aware, at 55, that i am on the edge of trouble. i take lots of calcium, had my vit d checked, and have brought that up. those things would not have happened without being told i was loosing bone density. yes, i was told i had a dx of osteopenia. but i was also educated that this was not a disease. just a warning that it was time to take some preventative measures to avoid serious trouble in the future. gee, isn't that what good medicine is about? why should i wait until my vertebrae start to crumble? do you think that if i take this stuff then they will stop pinching nerves, and just go back like they were? fractures in your 50's and older are just not what people think. they are not the simple broken bones of a young person. they can destroy your life. why should we wait until that happens to treat this? that is just stupid.

and as far as life style changes- although they are possible, in your 50's and 60's, you are just not going to change who you are. a few people do. very, very few. that is probably why doctors neither nag on it nor depend on it.

[HuckleB]

9. BS...

You like propaganda. I get it.

[mopinko]

10. and you like propaganda of your own flavor

i get that too.
why don't you try to answer some of the points i bring up instead of just pitching shit?

look, i am as big a skeptic as anyone in this forum. but some skeptics here just jump to their own tune no matter how much they think they are being open minded and analytical.

[HuckleB]

14. You keep telling yourself that.

I'm sure you will.

[mopinko]

17. such high minded discourse.

i am so impressed with your knowledge and intellect. you have completely won me over. :sarcasm:

[HuckleB]

18. You want me to waste my time.

I refuse.

You made a BS response. I called you on it. You are not intellectually honest enough to acknowledge your crap. Heck, you didn't even the piece posted in the OP.

That is all very clear.

Now try a mirror sometime, sarcastic one.

[mopinko]

19. i did read it, i heard the npr piece when it was broadcast.

and like i said, i have read and discussed this intensively with several docs, as i have a strong family history.
do you think your op was written with the help of the divine or something? yet everyone else's studies that are posted are crap?

[HuckleB]

22. Sure.

:eyes:

[DemReadingDU]

11. here is the link to NPR

12/21/09 How A Bone Disease Grew To Fit The Prescription
http://www.npr.org/templates/story/story.php?storyId=121609815

[HuckleB]

15. Been there already.

[DemReadingDU]

12. bisphosphonates may make bones more brittle

a few snippets

2/6/09 Do you really need a drug for your bones? by Dr. Susan E. Brown, PhD

The question is: does this make bone stronger? In my opinion, it’s always dangerous to work against nature. And though women who take bisphosphonates may appear to have denser bone initially on a bone scan, it doesn’t mean the bone is actually stronger. In fact, we know that bone naturally becomes less dense as we age, but what protects us from debilitating fracture is our inborn ability to repair, meaning to break down old bone and rebuild new bone naturally. And because this natural bone repair process is halted when on drugs like Fosamax and Actonel, it is very likely that using these drugs over the long haul will weaken, not strengthen, bone.

You may have read the recent news about women taking bisphosphonates for more than five years and spontaneously fracturing their femur bones while simply walking or standing. I had a patient who had been on Fosamax for four years, then turned in her bedroom one evening and fell to the floor, breaking her leg in two separate places. Though these “low-trauma” and “nontraumatic” fractures aren’t happening in all women on bisphosphonates, they certainly serve as a warning for those considering prolonged use of these drugs as “preventative medicine.” It also points to the fact that halting bone resorption doesn’t automatically give us stronger bones, and may in fact make them more brittle over time.

more...
http://www.womentowomen.com/bonehealth/osteoporosis-drugtherapy.aspx?

edit - changed subject line

[DemReadingDU]

13. Merck Faces First Trial of Claim That Fosamax Attacks Jawbone

8/10/09 Merck Faces First Trial of Claim That Fosamax Attacks Jawbone

Merck & Co., the drugmaker facing 900 lawsuits over claims that its osteoporosis drug Fosamax causes the death of jawbone tissue, goes to trial tomorrow in a case that may affect all the others.

The trial in New York of the first case of the group, filed by Shirley Boles, 71, will be one of three so-called bellwether cases that may point the way to out-of-court settlements.

“In mass litigation, all eyes are on the first trial, not only because it shows the strategy of each side, but also because it’s the first information about how jurors respond to the evidence,” said Howard Erichson, a law professor at Fordham University in New York and an expert on civil procedure.

Merck faced about 900 Fosamax cases as of June 30, including suits with multiple patients, the company said in an Aug. 3 regulatory filing. Whitehouse Station, New Jersey-based Merck, which is buying rival Schering-Plough Corp., had a reserve of about $42 million for the litigation, including lawyers’ fees, it said. It hasn’t set aside any money to pay damages, it said.

There are as many as 1,200 plaintiffs in state and federal cases, Merck says. Timothy O’Brien, a lawyer representing about 400 plaintiffs, said the number is closer to 2,000.

more...
http://www.bloomberg.com/apps/news?pid=20601127&sid=aN.O.OLorMnc


edit to add

9/11/09 Jury Deadlock Ends a Trial Over Merck’s Bone Drug
http://www.nytimes.com/2009/09/12/business/12drug.html


P.S. I add that it takes several jury trials in different parts of the country to determine whether there is enough basis to go forward. Remember that Merck was successfully sued by people taking Vioxx, and by families of people where their loved one died from taking Vioxx. Yes, my spouse was a part of that class-action suit. His mom was taking Vioxx, and with no prior indications of heart problems, she died of a heart attack in 2002. It has taken 7 years, but finally Merck decided to settle.

[uppityperson]

16. "what should doctors do" is an issue. Part of the problem is they are forced to do instant-medicine

rather than being able to spend time with people, talk about diet, exercise, etc beyond quick basics, they are pushed to go faster faster faster and can end up prescribing too much too fast.

"Big Pharma advertises but it is doctors who write the prescriptions: when drugs are over-prescribed, only the prescribers are to blame. What should doctors do? In the first place, they should be recommending preventive lifestyle changes to all their patients. "

And what should doctors do when the company they work for won't let them do that? When insurance companies won't pay them enough to be able to spend time doing that?

[Deep13]

20. Does the stuff work? If so, not a scam.

Is it ineffective or harmful? If so, not a scam.

[HuckleB]

23. Read the article, then respond, please.