Recently, I have been considering two chronic health conditions directly related to aging: atherosclerosis and osteoporosis. Both are usually considered “diseases for older people,” but both disease processes actually begin at a young age – as early as the 1930s and 40s. Both are very common, affecting more than 60 million people in the United States.
However, the paths for these two broad conditions vary greatly. In one case, between 1950 and 1996, the mortality rate dropped by 60%, and then continued to decline. On the other hand, the decline was moderate and it turned around since then. Although both conditions affect both sexes, one condition is usually associated with men and the other with women.
Although none of us will live forever, the advances in heart disease in modern medicine have really been amazing since the 1950s. Diagnostic tests, slow-progressing medications, open stent arteries, dramatic lifesaving procedures, the list continues. The fingertips of trained doctors and the use of these tools is relatively high, with over a hundred tests, medications, devices and procedures (always in the pipeline). The next generation of doctors and patients who see parents and grandparents die from a heart attack are often very motivated to be aggressive in preventing and treating them.
The treatment and attitudes for osteoporosis and its precursor osteopenia are contrasted in sharp contrast. The mortality rate after hip fracture remained basically unchanged for 50 years. From 1990 to 2020, the rate of hip fractures decreased by about 15% compared to the decline in cardiovascular events. But at least they keep falling. Unfortunately, this progress has now stalled. The fracture rate remained stable from 2012 to 2015 and then began to increase.
Why? Why are there so little progress in the rate of osteoporotic fractures and associated morbidity and mortality? Death is real, pain and pain are real – almost all of us have witnessed it. Of course, the $57 billion annual cost of health systems is real.
One explanation is the pharmacological challenge. One of the core treatments for osteoporosis is medicine. Although their efficacy in reducing fracture rates is undeniable, the side effects of bone-active drugs such as bisphosphonates are accompanied by ranging from unpleasant (such as GI distress) to rare but serious side effects (such as femoral fractures, bone nucleus of the jaw). For years, patients have been worried about these side effects, so much so that the percentage of patients who initiate osteoporosis medication has dropped from a height of 40% in 2002 to below 10% today. Even for those receiving medication, most treatments are recommended for 3-5 years (bisphosphonates) or 1-2 years (anabolic) because the risk-benefit ratio climbs during this period. There are also no widely pointed out drug therapies in osteopenia, nor are there long-term drug therapies. In other words, for high blood pressure, safe and effective drugs, we simply do not have the equivalent of the bone health world (or similar) in the bone health world of statins, to the point where it is initiated early and used indefinitely.
But this is just a superficial explanation. There is also a business reality. Innovation and investment stagnated and never came back after the first wave of pharmacological interventions for osteoporosis went on the market. Many of the largest pharmaceutical companies, including Lilly, Merck, Pfizer, etc., have exited the field. Some combination of high costs of conducting clinical trials to demonstrate fewer fractures and an extreme rebound against reactive drugs such as bisphosphonates and denosumab prompted the industry to rethink the profitability of such drugs. Reimbursement for the most effective anabolic drugs certainly did not help this business case. The result is that there is no new proxy in the later tests.
The illnesses that affect older women receive less attention or investment, either. This unfortunate intersection of ageism and prejudice against women affects the concerns of many health conditions from menopause to automatic immunization conditions.
But the root cause I see is more sinister, and this is our own acceptance. Receive women with fragility and fractures. Believe that osteoporosis is the “natural” part of aging. The image of the fragile little old lady has been deeply rooted in our expectations and worldview of older women. Thinking of the problem of osteoporosis as a lifestyle problem for women rather than a critical medical problem is affecting everyone. Diseases like heart disease and even cancer are also “natural” parts of aging, but we won't accept them without fighting. We try our best to prevent, delay, diagnose and treat these critical conditions. I believe we should fight vulnerability enthusiastically like we are fighting cancer.
It is time to challenge this inevitable myth and to make bone health deserve the urgency and importance. Our tools are underutilized, but require more investment, research and innovation. Most importantly, we need to raise our standards and expectations for bone health.
Let us all – patients, doctors, healthcare and pharmacology and device innovators and decision makers to change our perspective. Let’s set a goal, in addition to living longer and reversing the disturbing trend of today’s postmenopausal women living a long, strong, active and fearless life, we set a strong goal.
Photo: Computer illustration of Getty Images
Laura Yecies is the CEO of Osteoboost Health, the first and only FDA clearance, non-drug wearable company that can be used for low bone density. Under her leadership, OsteoBoost received a $4.7 million NIH grant, raised $11 million in private capital and generated $1 million in bookings within weeks of announcing the waitlist. She previously led a productivity application company sold to Apple, as well as Neurosync, a neurotech company. Earlier, she served as CEO of Sugarsync, where she earned $20 million and sold it to J2 Global. She has degrees from Harvard, Georgetown and Dartmouth.
This article passed Mixed Influencer program. Anyone can post a view on MedCity News' healthcare business and innovation through MedCity Remacence. Click here to learn how.
