Overdiagnosis of osteoporosis: fact or fallacy?

man reading Osteoporosis International journal
©Gilberto Lontro/IOF
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New article in Osteoporosis International provides comprehensive arguments that prove recent suggestions that osteoporosis is overdiagnosed are completely misguided.

An Editorial published this week in Osteoporosis International – an official publication of the International Osteoporosis Foundation (IOF) – responds to a recent article in the British Medical Journal (BMJ)1 that grossly misrepresented the osteoporosis burden. The Editorial which is authored by Prof. Juliet Compston, Chair of the National Osteoporosis Guideline Group and IOF EU Osteoporosis Consultation Panel, argues that the authors used selective and misleading presentation of published evidence.

The BMJ article entitled “Overdiagnosis of bone fragility in the quest to prevent hip fracture” by Järvinen et al., generated a concerted response from the bone, muscle and joint community who were outraged by the claims made in the paper. IOF leadership posted a rapid response on June 1 when the paper first came to light and encouraged their network, including: over 230 member organizations; Committee of Scientific Advisors and other stakeholders to leave their own comments. Of the total number of rapid responses published, one-third were from individuals or organizations associated with the IOF.

This new editorial provides comprehensive evidence as to why the article by Järvinen et al. was completely misleading. It details, amongst other arguments, how the authors:

  • Provide a biased critique of current strategies for risk assessment and prevention of hip fracture
  • Fail to mention Fracture Liaison Services, a model of care that has been shown to be both effective and cost-effective in the secondary prevention of fracture and has been successfully adopted in many parts of the world
  • Fail to make the distinction between primary and secondary fracture hence skewing the results presented
  • Use the terms bone fragility and osteoporosis interchangeably. This is incorrect, since factors other than BMD contribute to bone strength. In fact, there is not a single BMD T-score threshold that defines bone fragility
  • Claim that non-pharmacological interventions are overlooked. On the contrary all osteoporosis guidelines include counselling about life style, including diet, tobacco use and alcohol intake, and promote appropriate levels of physical activity
  • Assert that falls prevention may be as effective in reducing fracture as pharmacotherapy, which is a misrepresentation of current evidence

In addition, Dr Kassim Javaid, member of the IOF Capture the Fracture® Steering Committee, who was asked to review the Järvinen et al., paper and actually rejected it on the basis that “as in my opinion the data presented and conclusions drawn were false and would mislead patients, clinicians and academics.” called for clarification on the BMJ editorial process. He also asked that in the interests of transparency that “BMJ share not only my review but those of other reviewers, who must have clearly accepted the paper without changes as the published paper bears a striking resemblance to the one I reviewed and rejected so clearly”.

The bone, muscle and joint community certainly proved that when faced with such inaccurate and damaging articles they will take action and unite in the fight to protect the integrity of the many advances made in the osteoporosis field.  

> Read Editorial “Overdiagnosis of Osteoporosis: fact or fallacy
> View Dr Javaid’s and other rapid responses together with IOF’s supporting comment
Read IOF’s original response to BMJ article and other Letters to the Editor

Reference

1. Järvinen Teppo LN, Michaëlsson Karl, Jokihaara Jarkko, et al. Overdiagnosis of bone fragility in the quest to prevent hip fracture. BMJ 2015; 350:h2088 doi:10.1136/bmj.h2088.