How osteopenia became a disease and made Fosamax popular

How did osteopenia, the precursor to osteoprosis, come about?

Fascinating story from NPR, detailing how a drug company popularized the condition in order to expand the market for their drug, Fosamax.

Osteopenia is diagnosed via a bone density study showing a “T-score” between -1.0 and -2.5. But how that definition came about was quite arbitrary.

In 1994, a group of researchers from the World Health Organization poured over data, and eventually, a decision had to be made. Here’s what happened, according to Dartmouth professor of medicine Anna Tosteson:

“Ultimately it was just a matter of, ‘Well … it has to be drawn somewhere,’ ” Tosteson says. “And as I recall, it was very hot in the meeting room, and people were in shirt sleeves and, you know, it was time to kind of move on, if you will. And, I can’t quite frankly remember who it was who stood up and drew the picture and said, ‘Well, let’s just do this.’ ”

So there in the hotel room someone literally stood up, drew a line through a graph depicting diminishing bone density and decreed: Every woman on one side of this line has a disease.

Doesn’t sound very evidence-based.

But Merck ran with it, and lobbied Medicare to cover bone density studies – key to popularizing the condition. Once they did, the tests become more accessible, and more and more women wanted it. Many were then diagnosed with osteopenia, and subsequently, were put on Fosamax.

Voila, the birth of a disease, and one that was quite profitable for Merck.

The whole NPR piece is well worth reading.

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