Letters Guidance on osteoporosis

Say Dr No to shifting from falls to osteoporosis

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2684 (Published 25 November 2008) Cite this as: BMJ 2008;337:a2684
  1. Emilio Maestri, consultant endocrinologist1
  2. On behalf of Oreste Capelli, Giulio Formoso, Lucia Magnano, Anna Maria Marata, and Nicola Magrini
  1. 1Unit of Drug Evaluation and Evidence-Based Primary Care (CeVEAS), 41100 Modena, Italy
  1. boscoprofondo{at}tin.it

    As clinicians, we agree with shifting the focus in fracture prevention from osteoporosis to falls,1 and consider that loss of bone mineral is a risk factor rather than a disease.

    This shift is seriously challenged in information campaigns targeted at the public. In the timeless women campaign promoted by the International Osteoporosis Foundation and sponsored by Novartis, Ursula Andress declares: “Say Dr No to osteoporosis.” She describes how she didn’t take any drug after a bone mineral test and her T score was lower in the next examination. But now she’s saved from becoming a crippled old lady by the once a year drug produced by the company sponsoring the campaign.

    However, ageing is always accompanied by loss of bone mineral, but most elderly women do not develop fragility fractures. Physical exercise and healthy lifestyle are probably protective. And Ursula’s treatment prevents clinical fractures in only 4 out of 100 postmenopausal women, mostly those with pre-existing fractures.2

    The campaign also urges yearly bone checks immediately after the menopause, although no evidence exists for implementing such a strategy. The National Institute for Health and Clinical Excellence (NICE)3 did not recommend any screening to prevent osteoporotic fractures because of concerns about the predictive accuracy of bone mineral density and the lack of evidence that screening would reduce the incidence.

    Such a campaign risks transforming postmenopausal women into sick people, and promotes magic bullets rather than avoiding falls and adopting healthy lifestyles as the key to healthy bones.


    Cite this as: BMJ 2008;337:a2684


    • Competing interests: None declared.


    View Abstract

    Log in

    Log in through your institution


    * For online subscription