NOF’s new osteoporosis treatment guidelines: Are they kidding?

In April 2008 the U.S. National Osteoporosis Foundation published its new criteria for osteoporosis treatment, “Clinician’s Guide to Prevention and Treatment of Osteoporosis.” This handbook sets forth their official suggestions for treatment, which basically boil down to two sets of criteria for determining if a person should be given osteoporosis drugs. One criterion is based on bone density alone; the other concerns the assessment of fracture risk based on multiple risk factors other than bone density.

The guidelines were designed to help doctors determine who to treat and were well intended, but I can’t help but ask, “What do they mean?” What do these new NOF guidelines mean for women (the majority of osteoporosis patients), and just how many women would be treated with osteoporosis drugs if these guidelines were followed by doctors around the country?

Interestingly enough these same questions were asked by researchers from the noted U.S. Study of Osteoporotic Fractures. The answer they came up with is quite astounding. Applying these new criteria to women in the large, representative Study of Osteoporotic Fractures these researchers calculate that at least 72% of white women aged 65 and older, and 93% of women aged 75 and over, would be told to take osteoporosis drugs.

To me this is startling and rather frightening. First, as reported by the U.S. Surgeon General, only 17% of white women aged 50 older will experience a hip fracture in their life; 15% a vertebral fracture, and 16% a forearm fracture. Second, the side effects of these drugs are well noted and substantial — and they would be recommend to the vast majority of older Caucasian women. Third, I am perplexed at such a strong focus on drug therapy these days when science is now documenting the many life-supporting ways we can both prevent osteoporotic fracture and at the same time build better overall health. For example, many researchers, myself included, estimate that nearly half of all osteoporotic fractures could be prevented with adequate vitamin D supplementation with even greater results possible if all the key 20 bone-building nutrients were consumed in adequate amounts.

If you are interested in avoiding the risks of osteoporosis drug therapy, know that there are science-based, natural alternatives, and I am happy to share these with you. You can start by assessing your fracture risk through our simple fracture risk and bone health profile.

Wishing you all Better Bones and a Better Body.

References:

Donaldson, MG et al. Estimates of the proportion of older white women who would be recommended for pharmacological treatment by the new U. S. National Osteoporosis Foundation Guidelines. J Bone Mineral Res 2009; 24 (4): 675-674.

U.S. Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. U.S. Dept of Health and Human Services, Rockville, MD, 2004.

Brown, S.E. Vitamin D and fracture reduction: An evaluation of the existing research. Altern Med Rev 2008; 13(1): 21-33.