Do we care less about osteoporosis? Yes and no.

My thesis aims to understand why prescribing trends for osteoporosis medication in England and France have started declining since about 2008. Indeed, after a very sharp increase since the late 1990s, the trends in prescription started stagnating and declining in England and France respectively since 2008.
As I review the literature – very slowly I must admit – I come to the conclusion that the epidemiology of the disease – i.e. the number of people actually afflicted by the condition – is very unlikely to bear any responsibility in the trends. Changes in epidemiology of this nature are simply not that fast. Though Western societies are ageing, the demography is similarly not changing that quickly.
I have prepared a number oh hypotheses as to why this is occurring. I will not list them now as this is not the objective of this paper. One of them is that osteoporosis may be declining within the ranking of public agenda priorities.

Source: AlgaeCal

When I wrote this hypothesis, I thought to myself that this was quite unlikely considering the ageing of society and the increasing focus of healthcare on geriatric conditions. Every paper I read on osteoporosis usually start one way or another with ‘the burden of osteoporosis is immense’ and similarly concludes with ‘healthcare should increasingly focus on osteoporosis’.
However, I encountered a first hint that this hypothesis may not completely be unfounded and crazy.
I used Ngram – the Google tool searching for the occurrence of words within all published (and scanned) books – to search the occurrence of ‘osteoporosis between 1900 and 2014. The following graph displays the results of this search. They puzzled me.

Capture ngram

As expected the use of the word strongly increased more and more in the post Second World War time as research ad geriatric medicine developed. The trend even accentuates from the 1980s when discoveries around the identification of low bone mass and pharmaceutical management options were made.
What really stuns me is the decline in the use of the term (in proportion of all word usage, not in absolute numbers) started declining 2000/2001.
This decline takes place earlier than my data shows for the stagnation and decline of osteoporosis medication prescription trends but coincides nevertheless with a significant and coherent change.
I have no explanation as to why this is occurring, only hypotheses:

  • Less research is taking place / less discoveries are made
  • Less efforts are made to publicise the disease as deserving care
  • Osteoporosis causes less fractures

While the two first hypotheses are not easily answered in a log post, the latter is easier. A 2011 literature review reports that secular trends in fracture trends have started to stagnate and even decline [1]. This would need to go much further to satisfyingly conclude on the topic but this is one first interesting clue. It seems like we care less about osteoporosis. However, this decline may actually be associated with the decrease of the importance of the burden associated with osteoporosis.

[1] C. Cooper, Z. A. Cole, C. R. Holroyd, S. C. Earl, N. C. Harvey, E. M. Dennison, L. J. Melton, S. R. Cummings, J. A. Kanis. Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporosis International, 2011, Volume 22, Number 5, Page 1277


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