Osteoporosis and orthopaedics - a GP writes

Periodically there is a new thrust to galvanise the orthopaedic community about osteoporosis, the consequences of which we are more familiar with than the average doctor.

It never really appealed to me as an area of practice, but intellectually it didn't really convince either. If the inevitable decline in bone mass which affects all of us (exacerbated by the menopause in women) is causing fractures, then the only really effective measure is probably to maximise one's peak bone mass, and be sensible in the subsequent years. In other words, it's mainly how you eat, exercise and smoke from your teens to your late twenties. The same applies thereafter to a lesser extent, but if you start your descent from a very high altitude....It makes sense to me.

What doesn't make sense is to start people on expensive medication, often with a low compliance rate, in their pensionable years. It strikes me as another industry-driven initiative, at least in part, with some similarities to the aggressive marketing of chemical thromboprophylaxis for arthroplasty, based primarily on surrogate outcomes. One cannot tell an individual patient that it is definitely in their best interests, in my view.

Please note that I am not referring to premature osteoporosis, osteomalacia or any other true metabolic pathology. They are entirely different matters.

Anyway, I'm not alone. Fons Sips died this July, aged 76. He was a pioneering Dutch GP, of great renown. Here is an excerpt from his BMJ obituary:

He has a point