BMJ  2008;336 (19 January), doi:10.1136/bmj.39462.555197.47

Editor's Choice

Absolute risk please

The first 150 words of the full text of this article appear below.

The BMJ has a noble tradition of fighting the trend to medicalise risk factors (BMJ 2002;324:886-91; doi: 10.1136/bmj.324.7342.886). This week we hear more about whether we should be treating women who have "pre-osteoporosis," otherwise known as osteopenia—bone mineral densities that are slightly below normal. These women are at low risk of fracture but are considered by some to be "at risk of being at risk." They comprise more than half of the world’s postmenopausal women.

Pablo Alonso-Coello and colleagues examine four post hoc analyses of trials of osteoporosis drugs that claim to support drug treatment for osteopenia (p 126; doi 10.1136/bmj.39435.656250.AD). They find that the benefits of treatment in these low risk women are overstated and the harms underplayed. They urge clinicians to base treatment decisions on absolute rather than relative risk. It’s a lesson worth repeating: "impressive sounding reductions in relative risk can mask much smaller . . . [Full text of this article]

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