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Inappropriate prescribing for osteoporosis

Ego Seeman, Mark A Kotowicz, Peter T Nash and Philip N Sambrook
Med J Aust 2009; 191 (6): 355-356.

To the Editor: Nordin and colleagues raised important issues about prescribing for osteoporosis.1 We agree that the Pharmaceutical Benefits Schedule guidelines for therapy are imperfect, but they do not necessarily lead, as Nordin et al claim, to inappropriate prescribing. For historical reasons, osteoporosis is held to be synonymous with vertebral fractures, but this misrepresents the epidemiology of fractures. Non-vertebral fractures account for 80% of all fractures and 90% of the loss of quality of life and economic costs. Vertebral fractures contribute only 20% of the burden.2 Most fractures arise in the large population at moderate risk with osteopenia — the “bell” of the Gaussian bone mineral density (BMD) distribution, not its “tail”, which comprises those with osteoporosis (defined by a bone densitometry T-score less than – 2.5). Concentrating on vertebral fractures and screening for osteoporosis with bone densitometry, as recommended by Nordin et al, is no solution to this public health problem.

  • Ego Seeman1,2
  • Mark A Kotowicz1,2
  • Peter T Nash1,3
  • Philip N Sambrook1,4

  • 1 Australian and New Zealand Bone and Mineral Society, Sydney, NSW.
  • 2 Department of Medicine, University of Melbourne, Melbourne, VIC.
  • 3 School of Medicine, University of Queensland, Brisbane, QLD.
  • 4 Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW.

Correspondence: anzbms@racp.edu.au

Competing interests:

Ego Seeman serves on the medical advisory committees of and has received speaker fees from Amgen, Eli Lilly, Merck Sharp and Dohme, Novartis, Procter and Gamble, Sanofi-Aventis and Servier. Mark Kotowicz serves on the Novartis Alcast medical advisory board and has received speaker fees and travel assistance from Merck Sharp and Dohme, Sanofi-Aventis and Servier. Peter Nash received research funding for clinical trials, and honoraria for advice from Eli Lilly, Merck Sharp and Dohme, Novartis, Sanofi and Servier, and has also lectured on their behalf. Philip Sambrook serves on the medical advisory boards of and has received speaker fees from Amgen, Merck Sharp and Dohme, Novartis, Sanofi-Aventis and Servier.

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