Overdiagnosis and osteoporosis
A BHMA trustee tells of his own encounter with over-diagnosis. He raises the question of risk versus benefit and the vexed question of NNT – ‘the number needed to treat’ – statistically how many people would have to be treated in order to prevent a single severe outcome. Anyone thinking of embarking on a lifelong drug regime whether for high cholesterol, raised blood pressure or in this case ‘osteoporosis’ should ask their doctor about NNT and, crucially, whether the drug carries significant risks of severe adverse effects. The author having done so, rejected medication in favour of lifestyle changes which appear to have been highly effective.
I am a ’healthy‘ 68-year-old man who four years ago was diagnosed with osteoporosis in the spine and osteopenia in the hip following a minor accident at home. I had no obvious predispositions, other than a genetic link on the female side with my sister, aunt and grandmother, although in the preceding four years I had cracked a rib and broken toes twice. Following my DEXA scan I was alarmed to be told I had an advanced medical ‘condition’ and was urgently in need of drugs (I was recommended 18 months of parathyroid hormone – PTH – followed by continuous bisphosphonates).