Osteoporosis is a disease that causes bones to become thinner, more porous and break more easily. Osteopenia is different from osteoporosis — it is a slight thinning of bones that occurs naturally as women get older and typically doesn’t result in disabling bone breaks.
Osteopenia is a condition that only recently started to be thought of as a problem that required treatment. Until the early 1990’s, only a handful of people had even heard of the word. But osteopenia has transformed from a rarely heard word into a problem that millions of women swallow pills to treat.
The term “osteopenia” was never originally meant to be considered as a disease — it was a research category used mostly because some thought it might be useful for public health researchers who like clear categories for their studies.
But in 1995, a man named Jeremy Allen was approached by the drug company Merck. The pharmaceutical giant had just released a new osteoporosis drug called Fosamax. Since osteoporosis is a serious problem that affects millions of women, the potential market for Fosamax was enormous. But the drug wasn’t selling well.
Allen persuaded Merck to establish a nonprofit called the Bone Measurement Institute. On its board were six of the most respected osteoporosis researchers in the country.
But the institute itself had a rather slim staff: Allen was the only employee.
In 1997 the institute and several other interested organizations successfully lobbied to pass the Bone Mass Measurement Act, a piece of legislation that changed Medicare reimbursement rules to cover bone scans. More and more women got bone density tests (at Merck’s urging), and the very existence of the word “osteopenia” on a medical report had a profound effect.
Millions of women were worried by the diagnosis. And when clinicians saw the word ‘osteopenia’ on a report, they assumed it was a disease. Merck did not disabuse them of the notion.
There are no long-term studies that look at what happens to women with osteopenia who start Fosamax in their 50’s and continue treatment long-term in the hopes of preventing old-age fractures. And none are planned.
Resources:
WHO FRAX
NPR December 21, 2009
NPR 2009 (Sample Radiology Report)
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