BMJ  2008;336:126-129 (19 January), doi:10.1136/bmj.39435.656250.AD

Analysis

Drugs for pre-osteoporosis: prevention or disease mongering?

¹ Iberoamerican Cochrane Center, Department of Clinical Epidemiology and Public Health, Hospital de Sant Pau (Universidad Autónoma de Barcelona), 08041, Barcelona, Spain, ² Servicio Madrileño de Salud, Madrid, Spain, ³ Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada, ⁴ Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia

After looking at data used to support treatment of women with slightly lowered bone mineral density, Pablo Alonso-Coello and colleagues argue thatproponents have overstated the benefits and underplayed the harms

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

Osteoporosis is a controversial condition. An informal global alliance of drug companies, doctors, and sponsored advocacy groups portray and promote osteoporosis as a silent but deadly epidemic bringing misery to tens of millions of postmenopausal women.¹ For others, less entwined with the drug industry, that promotion represents a classic case of disease mongering—a risk factor has been transformed into a medical disease in order to sell tests and drugs to relatively healthy women.² Now the size of the osteoporosis market seems set to greatly expand, as the push begins to treat women with pre-osteoporosis. These are women who are apparently at risk of being at risk, a condition known as osteopenia that is claimed to affect more than half of all white postmenopausal women in the United States.³ We examine the evidence from four post-hoc analyses of trials of osteoporosis drugs that is claimed to support this move.

Expanding an already controversial condition

In 1994 . . . [Full text of this article]

Treating those at risk of being at risk?

Reanalysis: science in the service of marketing?

Exaggerating benefits

Playing down side effects

Potential conflicts of interest

Where to from here?

Summary points

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Rapid Responses:

Read all Rapid Responses

Drugs for pre-osteoporosis: an example of prejudice-based medicine?

Juliet E Compston, et al.
bmj.com, 10 Feb 2008 [Full text]

Osteoporosis is not a controversial condition

Ego Seeman, et al.
bmj.com, 15 Feb 2008 [Full text]

More disease mongering?

Onisillos Sekkides
bmj.com, 20 Feb 2008 [Full text]

Osteoporosis is a disease which can be treated

Rene RIZZOLI, et al.
bmj.com, 28 Feb 2008 [Full text]

Drugs for pre-osteoporosis: prevention or disease mongering?

Pablo Alonso-Coello, et al.
bmj.com, 6 Mar 2008 [Full text]

Drugs for pre-osteoporosis: prevention or disease mongering?

Ray Moynihan
bmj.com, 6 Mar 2008 [Full text]

Excellent Paper

Robert Marx, et al.
bmj.com, 7 Mar 2008 [Full text]