Re: “Commentary: Osteoporosis is a public health crisis. It doesn’t have to be” (Dec. 1):

Osteoporosis is indeed a public health crisis, causing significant disability and death, generally among postmenopausal women. It is not a disease but, rather, a condition, related most directly to the natural loss of estrogen with aging.

Screening should clearly be encouraged because there are interventions, including newer drugs, that can reduce fracture risk and attendant complications significantly. However, the goal of screening is to identify those who should be treated; it is not a treatment in and of itself. And treatment can be very expensive.

A course of a more effective injectable bone builder, for instance, involves a refill of the drug every four weeks for two years. The monthly list cost is as high as $4,000. And even with insurance or Medicare coverage, copays are very high. So, anyone deciding to undergo screening needs to consider their ability to afford treatment. Many women do just this and opt not to bother.

It is appropriate to advocate for increasing access to screening but not particularly beneficial if many – if not most of those diagnosed with the condition – cannot afford treatment. We need to advocate for women’s health by establishing both access to screening and providing affordable treatment – and not just for osteoporosis. And, in fact, not just for women. All of us deserve affordable health care.

Alison Fulmer

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