Drugs for pre-osteoporosis: Prevention or disease mongering?

Osteoporosis is a controversial condition. An informal global alliance of drug companies, doctors, and sponsored advocacy groups portray and promote osteoporosis as a silent but deadly epidemic bringing misery to tens of millions of postmenopausal women.1 For others, less entwined with the drug industry, that promotion represents a classic case of disease mongering—a risk factor has been transformed into a medical disease in order to sell tests and drugs to relatively healthy women.2 Now the size of the osteoporosis market seems set to greatly expand, as the push begins to treat women with pre-osteoporosis. These are women who are apparently at risk of being at risk, a condition known as osteopenia that is claimed to affect more than half of all white postmenopausal women in the United States.3 We examine the evidence from four post-hoc analyses of trials of osteoporosis drugs that is claimed to support this move.