Disease diagnoses, medicalization, and the loss of personal responsibility in health: a review of the research as it relates to osteoporosis

osteoporosis

The following guest post is written by Charles T. Price, MD, rated one of America’s Top Doctors by U.S. News & World Report.

The term medicalization generally refers to social or psychological conditions such as alcoholism, hyperactivity, or other disorders that become defined and treated as disease states. Medicalization provides a diagnosis that may decrease feelings of guilt, but may also decrease the willingness of the individual to assume personal responsibility for improving their condition and make lifestyle changes. Doctors then prescribe strong medications that have been developed to manage every possible condition from natural aging (like low testosterone), to obesity. The Saint Jude Retreats has called attention to the hazards of medicalizing the diagnosis of alcoholism, but this temptation runs through other areas of disease management.

Some of this medicalization is driven by the pharmaceutical industry as they find more and more conditions that can be managed with pharmaceuticals, at great profit. In “Selling sickness: the pharmaceutical industry and disease mongering”, Dr. Iona Heath, former chairman of the ethics committee for the British Medical Journal, writes “these ‘disease awareness’ campaigns are commonly linked to companies’ marketing strategies – they operate to expand markets for new pharmaceutical products.” Alternative approaches that emphasize the importance of personal change are often played down or ignored.

Osteoporosis is one field that has been medicalized and promoted by the pharmaceutical industry more recently.  In 1994, Merck Manual medicalized their definition of osteoporosis, but prior you actually had to fracture a bone from minimal impact to be diagnosed.  While osteoporosis is a major cause of disability and death in the senior population, the U.S. Surgeon General states, “…the evidence clearly suggests that individuals can do a great deal to promote their own bone health.” This suggests that over-reliance on drug treatments may not be the best method of managing low bone density.

In The Myth of Osteoporosis, Gillian Sanson explains how drug companies overstate the significance of osteoporosis drugs. For example, a large study of women taking bisphosphonates (the class of drugs for the medical treatment of osteoporosis) determined they had a 44% decrease in vertebral fracture risk. Sounds impressive, but compared to those who did not take the drug, the actual fracture risk amounted to just over 1%. Nonetheless, drug companies exploited the statistic.

A major concern is that women who have low bone density but have never had a fracture are diagnosed with osteoporosis and given powerful prescription drugs. To understand the risk of over medicating, look at a review of osteoporosis treatment studies from The Cochrane Collaboration. Common bisphosphonates Actonel and Didronel were compared to no treatment, or to nutritional supplements, to determine if the medications reduced the risk of fracture. The medications proved the same as no treatment for preventing a first fracture. [1,2]  Another drug, Fosamax, helped prevent initial vertebral fractures but had no benefit for other types of fracture.[3]

In spite of these studies women are diagnosed with osteoporosis only on the basis of bone density, which is frightening. Nutritional supplements, exercise, fall prevention and lifestyle changes are a safer response to low bone density. The first step is to eliminate poor health habits such as cigarette smoking, excessive alcohol consumption, and inactivity. Exercise is important for building bone density. The typical American diet is deficient in several nutrients that are critical for bone health, which requires that adults add an advanced supplement. The National Osteoporosis Foundation, Institute for Better Bone Health and other organizations recognize that calcium and vitamin D are not enough. Silicon is increasingly recognized for its role in activating bone calcification, improving bone density, supporting collagen production, and reducing the risk of fracture – which contribute to osteoporosis.

To be clear, there are many conditions such as injuries and cancer that are more dependent on intensive medical management than on the efforts of the individual. There are also aspects of social disorders and natural aging that benefit from some medical management. However, there should be a larger emphasis on the role of the individual to manage their own health and avoid unnecessary medications.

  1. Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Welch V, Coyle D, Tugwell P. Risedronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004523. DOI: 10.1002/14651858.CD004523.pub3.

http://www.ncbi.nlm.nih.gov/pubmed/18254053

  1. Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Robinson V, Coyle D, Tugwell P. Etidronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Jan 23;(1):CD003376. doi: 10.1002/14651858.CD003376.pub3.

http://www.ncbi.nlm.nih.gov/pubmed/18254018

  1. Wells GA, Cranney A, Peterson J, Boucher M, Shea B, Welch V, Coyle D, Tugwell P. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database of Systematic Reviews 2008, Issue 1. Art.

http://www.ncbi.nlm.nih.gov/pubmed/18253985

Charles T. Price, MD is a pediatric orthopedic surgeon and faculty member of the orthopedic residency program at Orlando Health: and Professor of Orthopedic Surgery at the University of Central Florida, College of Medicine. Dr. Price has authored more than sixty texts. His latest book, Can You Feel It In Your Bones? How a Doctor’s Quest Uncovered the Hidden Benefits of Silicon for Bone Health, is available at Amazon. Dr. price is President and co-founder of Institute for Better Bone Health (IBBH), a team of renowned orthopedic surgeons that developed breakthrough Silical® supplements, Silical System and Silical Boost.

Learn more at www.bonehealthnow.com.