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Analysis Too Much Medicine

Overdiagnosis of bone fragility in the quest to prevent hip fracture

BMJ 2015; 350 doi: (Published 26 May 2015) Cite this as: BMJ 2015;350:h2088

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Conflicts of interest among advocacy organisations and specialist societies

The debate following the recent article by Jarvinen and colleagues illustrates the difficulties in devising strategies to prevent fractures. 1 Jarvinen and colleagues highlight that most fractures occur in patients who do not have low bone density, and that the thresholds of fracture risk at which current fracture prevention strategies recommend pharmacological treatments mean that very large numbers of older people are recommended for treatment, but the majority of those treated do not benefit. On the other hand, correspondents from advocacy groups and specialist societies focus on the societal burden of fractures and the relative underuse of pharmacological treatments in patients who have had fractures, and contend that osteoporosis is underdiagnosed. Since pharmacological treatments and the measurement of risk factors for fracture (such as bone density or vitamin D levels) are both profitable and central to the debate, conflicts of interest are highly relevant.

None of the correspondents representing advocacy organisations (the International Osteoporosis Foundation, the National Bone Health Alliance) or specialist societies (the American Society for Bone and Mineral Research, the European Calcified Tissue Society, the International Society for Clinical Densitometry) declared conflicts of interest for the organisation. However, each organisation has corporate sponsors with vested interests in the diagnosis and/or management of osteoporosis. On their respective websites, the International Osteoporosis Foundation lists 20 corporate sponsors (, the National Bone Health Alliance 13 corporate sponsors (, the American Society for Bone and Mineral Research 4 corporate sponsors (, the European Calcified Tissue Society 4 corporate sponsors ( and the International Society for Clinical Densitometry 10 corporate sponsors ( The International Osteoporosis Foundation acknowledges that its existence depends on commercial sponsorship ( Relationships with corporate sponsors may influence the advice offered by osteoporosis advocacy groups.2 Publications, position statements and correspondence from organisations that are supported by companies with vested interests in the subject should be accompanied by a declaration of financial conflicts of interest.

1. Järvinen TLN, Michaëlsson K, Jokihaara J, Collins GS, Perry TL, Mintzes B, et al. Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ 2015;350:h2088.
2. Grey A, Bolland M. Web of industry, advocacy, and academia in the management of osteoporosis. BMJ 2015;351:h3170.

Competing interests: Andrew Grey is a shareholder in Auckland Bone Density, a company that provides bone densitometry services. Mark Bolland has no conflict of interest.

10 August 2015
Andrew Grey
Associate Professor of Medicine
Mark Bolland
University of Auckland
Private Bag 92019, Auckland, New Zealand