In 1992, the World Health Organization (WHO) Study Group on Assessment of Fracture Risk and its Application for Postmenopausal Osteoporosis met and subsequently published their findings and recommendations. The major aim of the group was to evaluate available methods for the assessment of fracture risk and how those methods could be used in screening for osteoporosis.
Up to this point, the term osteoporosis was used without clear meaning. The official definition that was agreed upon by the study group was “a disease characterized by low bone mass and micro‐architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.” 1
It was further decided that four general diagnostic categories be formed for women based on the bone mineral density (BMD). There were:
- Normal – A BMD within 1 standard deviation (SD) point of a young adult reference mean.
- Osteopenia (low bone mass) – more than 1 but less than 2.5 SD below the young adult reference mean.
- Osteoporosis – A value of 2.5 SD or more below the young adult reference mean.
- Severe or Established osteoporosis – more than 2.5 SD below the young adult mean with a fracture.
The WHO indicates in this report that these values were being arbitrarily set, and that BMD is not a certain predictor of fractures. That is, an individual with a BMD of 2.5 SD below the reference will have an increased risk for fracture but will not invariably fracture. And conversely, someone with a low risk may sustain a fragility fracture. Nonetheless, the issues of better identifying “at-risk” individuals and promoting prevention and treatment plans were seen as highly important.
The WHO was alarmed that the aging population throughout the world was increasing putting an additional burden on health providers and economics since, with age, there is an increased demand for health services. Equally as concerning was the finding that hip fracture rates in some countries were not staying level but actually growing within the also increasingly aging population.
This 129‐page report went on to discuss the issues of fractures, diagnosis, bone quality, prevention and treatment in‐depth. However, for our purposes, the report stands as a marker for understanding the birth of the osteoporosis craze.
Current Statistics on Fragility Fractures
The National Osteoporosis Foundation lists these facts on their website2:
- Osteoporosis affects an estimated 44 million Americans or 55 percent of people 50 plus years of age.
- 10 million individuals in the US are estimated to have the disease and almost 34 million more are estimated to have osteopenia. Of the 10 million Americans, eight million are women and 2 million are men.
- Osteoporosis is responsible for more than 1.5 million fractures annually.
- An average of 24 percent of hip fracture patients age 50 and over die in the year following their fracture. Six months post hip fracture, only 15 percent of patients can walk across a room unaided.
- Estimated national direct care costs (hospitals, nursing homes, and outpatient services for osteoporotic fractures is $18 billion per year and rising.)
Is Osteoporosis a disease that is being overdone?
Here are a few experts that say yes:
“I think even people who agree that osteoporosis is a serious health problem can still say it is being hyped. It is hyped.” Mark Helfank, MD, MPH, MS of Oregon Health and Science University in Portland in a Washington Post quote of 2000. He goes on to say “Most of what you can do to prevent osteoporosis later in life has nothing to do with getting a test or taking a drug.” 3
“I rarely criticize drug companies, but in this case I have to say the publicity about osteoporosis is mostly about profits, not about women’s health.” Marcelle Pick, OB/GYN NP on the Women to Women website.4 Women to Women is the holistic clinic co‐founded by leading author and holistic OB/GYN Christiane Northrup, M.D.
Dr. Nelson Watts, a leading expert in osteoporosis believes the term osteopenia should be eliminated. He feels alarming women in their 30s and 40s with a medical label that they can then worry about for the next 50 years, when most have normal bones is not helpful. “Because the term “osteopenia” is not useful as a diagnosis and can actually be harmful, I am on a personal crusade to eliminated it from the bone density lexicon,” shares Dr. Watts in “What is osteopenia, and what should be done about it?” 5 He further states that he try to avoid using the term with patients and instead opts for low bone density. “which does not sound like a medical problem in and of itself, and (I hope) is a nonjudgmental term that should force the clinician to think about the clinical context.”
Dr. Steven Cummings, also an expert, advices against the routine treatment of patients labeled with osteopenia. Most of these patients have a low risk for fracture and trials indicate that bisphosponate treatment for 4-7 years in this population has, at best, a small effect on fracture risk. Dr. Steven R. Cummings, of the University of California in San Francisco.
“There is no basis, no biological, social, economic or treatment basis, no basis whatsoever, for using minus one (referring back to the -1 SD point below the healthy adult mean BMD),” Dr. Cummings said. “As a consequence, though, more than half of the population is told arbitrarily that they have a condition they need to worry about.” 6
Within most discussions on osteoporosis, one will find experts on both sides of the camp related to treatment and outcomes. The discussion remains quite robust and non-definitive.
What do the Experts agree upon?
It appears that most all agree that post-menopausal women with BMD results of -2.5 or greater should receive drug treatment when other fracture risk factors are present. Examples of other risk factors include family history, medical history, loss of height, and falls.
How should a client/student proceed?
We, as Somatic Educators (Feldenkrais Method® practitioners, Bones for Life® Teachers, et al.) should not be in a position of influencing people to act against medical advice. Nor should we give the impression that what they have been told by their doctors may be faulty. Yet, we can empower our clients to talk with their doctor in-depth. We can give them an article or two to read and take with them to their doctor’s appointment with questions in hand. This will allow a quality discussion. If they are unsure of what has been recommended, we can empower them to seek a second opinion. Even another physician specialty, such as an Endocrinologist could be helpful and may yield a different perspective than the Family Practitioner or Internist.
A great article for clients to read, formulate questions, and take with them to their doctor’s visit is Dr. Watt’s What is osteopenia, and what should be done about it? It is a continuing education article written for physicians yet highly readable. Follow the link on the web and you can print out an on‐line copy at no charge. You can also reference our Issue 2 for a more comprehensive list of helpful articles.
By understanding the birth of the current osteoporosis craze, we can see that the WHO had a legitimate concern… increasing fragility fractures in an increasingly aging population. How the field has evolved since that time, shaped by technology, pharmaceutical companies, media, physicians, patients and fear is another matter and open to debate. We can agree that we all wish to age as healthy as possible and hope to live out our lives without diminished height, posture or broken bones.
Cynthia M. Allen is a Guild Certified Feldenkrais Practitionercm and Bones for Life® Teacher/Trainer. She has a private practice in Cincinnati, Ohio. You can find out more about her and her practice at futurelifenow.com. Cynthia Allen can be reached by email at CynthiaAllen@FutureLifeNow.com.
- WHO Technical Report Series 1994; 843:3-5
- http://www.nof.org/osteoporosis/diseasefacts.htm (accessed Oct 2007)
- Boodman, S; Hard Evidence. The Washington Post, Sep 26, 2000
- Pick, M,Osteoporosis and Fosamax. http://www.womentowomen.com/bonehealth/osteoporosis.asp, 2007
- Watts, NB; What is Osteopenia, and what should be done about it?. Cleveland Clinic Journal of Medicine. Jan 2006; 73:1:31-2
- Kolata, Gina, Bone Diagnosis Gives New Data But No Answers. New York Times, 2003