Osteoporosis – weakening of the bones – is a Cinderella disease.
It gets remarkably little attention from the public and GPs, in relation to its huge impact on public health: 230,000 people suffer osteoporotic fractures every year in the UK, at a total cost to the NHS and government of £2.3bn.
My colleague Margaret McCartney drew attention to it in her FT column recently and at the British Science Festival in Guildford today osteoporosis specialists were working hard to raise the profile of the disease.
They drew attention to potent new drugs that are due to be licensed later this year in the US and Europe, though there is some doubt whether NHS patients will see much benefit from them, since they may be too expensive to pass the value-for-money tests of NICE, the National Institute for Health and Clinical Excellence.
Neil Gittoes, consultant endocrinologist at Queen Elizabeth Hospital in Birmingham, and David Reid, professor rheumatology at the University of Aberdeen, said the availability of a relatively cheap generic treatment – alendronate, originally marketed by Merck as Fosamax – for about £50 a year in the UK was inhibiting the introduction of more sophisticated osteoporosis treatments.
Other drugs in the same bisphosphonate class, such as risendronate, ibandronate and, most recently, zoledronate exist in longer acting versions which may be superior for some patients. A single injection of zoledronate, sold by Novartis as Zometa, may last for a year. But these alternative bisphosphonates cost five times as much as alendronate.
Denosumab, a monoclonal antibody developed by Amgen, is likely to be licenced later this year. Antibody treatments are more expensive than the most costly bisphosphonates, so it is hard to see denosumab being used extensively in the UK.
Pointing out the high prevalence of osteoporosis, Margaret McCartney quoted the estimate that one in three women and one in 12 men over the age of 50 suffer a fracture due to osteoporosis at some point. According to Dr Gittoes the figures are even worse: one in two women and one in five men over 50 suffer such fractures.
Whatever the true figure, there is no doubt that the medical profession and society as a whole must do more to educate people at a much younger age about the dangers of osteoporosis and the need to keep their bones healthy, particularly through appropriate exercise and diet.