Overdiagnosis of bone fragility in the quest to prevent hip fracture

‘Stop smoking, be active and eat well’ is the cheering conclusion of this refreshing review of the overdiagnosis of bone fragility!

We are told 175 women must be treated for three years to prevent each hip fracture. Do you know what, I’m absolutely not surprised. Because this story mirrors so many other similar overdiagnosis and overprescribing stories I have watched develop over the past 25 years

1- Find something scary like heart disease, diabetes or hip fractures.
2- Look for a surrogate marker like cholesterol, HbA1c or bone mineral density.
3- Frighten well people by talking of ‘epidemics’ et cetera.
4- Frighten doctors by talking of relative risks rather than number needed to treat (NNT).
5- Definitely don’t mention common side effects or number needed to harm (NNH).
6- Definitely don’t mention overall mortality or morbidity.

I was equally not surprised to read under ‘research news’ in the same edition of the BMJ, a huge meta-analysis looking at blood pressure lowering agents in adults with renal disease and diabetes showed no benefit of treatment if all-cause mortality is looked at.

I sound a bit peevish I know, but because we struggle with limited energy and other resources it’s distressing to see so much wasted energy and effort. In a way it’s worse than that because of how worry affects our patients' lives. They really do worry about a low bone density or a high blood pressure, and yet these are not actual diseases at all - just possible risk factors. Often far less important than age, smoking, central obesity or lack of exercise.

So ‘Stop smoking, be active and eat well’