Letters Bad medicine: osteoporosis

Oversimplification is dangerous

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1062 (Published 23 February 2010) Cite this as: BMJ 2010;340:c1062
  1. J Joseph, consultant physician and rheumatologist1
  1. 1Nicosia, Cyprus
  1. drjoseph{at}cytanet.com.cy

    Spence makes some important points about osteoporosis1:

    • A DEXA result should not be considered in isolation but only in conjunction with all of the other risk factors for fracture2

    • Be alert to how the pharmaceutical industry might influence the presentation of diseases, treatments, and research outcomes

    • Overuse of any drug, including bisphosphonates, without good evidence is dangerous to patients

    • Some practices and doctors who use bisphosphonates inappropriately need training and educational sessions on the subject and probably more guidance from experts.

    However:

    • The National Osteoporosis Society does not “say” things about osteoporosis: it quotes the risk of fractures on the basis of decent epidemiological studies, many from the UK, by people who devote much of their time to the subject3

    • Don’t underestimate the role of adequate nutrition, including vitamin D.4 To say that these factors play little part is easy from the comfort of the developed world, but it ignores less affluent and informed people and those with a genetic predisposition to low body mass index or low vitamin D values.

    By all means work towards clarifying risk factors and towards proper, safe use of drugs without the influence of the drug industry. But oversimplifying osteoporosis and ignoring its tragic and fatal consequences is dangerous.

    Notes

    Cite this as: BMJ 2010;340:c1062

    Footnotes

    • Competing interests: JJ is vice chairman and head of the scientific committee of Cyprus Society against Osteoporosis, a voluntary organisation raising awareness among public and doctors on issues, including the appropriate use of drugs for osteoporosis.

    References