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    Tuesday, May 25, 2004

    Redefining Normal: How do you get an insurance company to pay for a drug so that more people will take it? Do a study that shows even asymptomatic people benefit from it, as in this osteoporosis study:

    A study suggests some women might benefit from taking bone-boosting drugs earlier than many doctors recommend, because they can break bones well before they develop full-fledged osteoporosis.

    The study involved 149,524 white postmenopausal women, age 65 on average, who had bone density scans. Of the 2,259 who broke bones during the following year, 82 percent had initial bone-density scores indicating thinning bones but not osteoporosis.

    Only 18 percent of women with fractures had scores at or above the threshold many doctors use to define osteoporosis and to prescribe drugs.

    The study was led by Dr. Ethel Siris at Columbia-Presbyterian Medical Center and included researchers from Merck & Co., which makes the osteoporosis drug Fosamax and funded the study. A Merck doctor participated in a committee that oversaw the study design and analysis, Siris said.

    I hate to burst their bubble, but even people with healthy bones can break them. All you have to do is fall with enough force or awkwardness. A fracture is not necessarily a sign of bad bones.

    The study's abstract says that there were 57,421 postmenopausal women with normal bone densities and out of those 1130 had fractures during the year of the study. That's only 2%. (Not sure why there's such a marked difference between the news story's numbers and the abstract's, unless there's some sort of information in the subscription only body of the text that disqualifies a lot of the subjects and increases the number of those who sustained fractures. Hard to understand how that could be, though.)

    The abstract doesn't make clear what kind of fractures these were, whether they were from accidents and pratfalls, or if they were the sort of spontaneous, surprise fractures that happen in osteoporosis. It's not inconceivable that two percent of women over 65 fall at some point over a year's time. Are these researchers really suggesting that taking osteoporosis drugs will prevent all, or even most, fractures in healthy bones? If so, we'd better start giving them to those tree-climbing, swing-jumping monkeys we call children.


    posted by Sydney on 5/25/2004 07:59:00 AM 0 comments


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