'CAUSE THAT'S WHERE THE MONEY IS:

[R]ecent reports suggest that too many younger women are being evaluated and treated for bone loss when they should not be.

The standard in bone screening is dual energy X-ray absorptiometry, or DXA, a relatively inexpensive test that measures bone mineral density and is usually covered by insurance. But the consensus among physician groups is that healthy women who are not at any particular risk for osteoporosis should not even be tested until they turn 65.

This year, the American Academy of Family Physicians cited the scans among five tests that are often performed unnecessarily and may lead to overtreatment of patients. Yet 20 percent to 60 percent of family physicians and internists have been performing DXA scans on younger women. Too much screening often leads to too much treatment, doctors say.

"If you do testing earlier on and you identify osteopenia or osteoporosis, then you're compelled to want to treat these folks," said Dr. Glen Stream, president of the American Academy of Family Physicians.

For low-risk patients with modest bone loss, or osteopenia, bisphosphonates like Fosamax and Boniva may do more harm than good, Dr. Stream noted.

In May, the Food and Drug Administration warned that while the drugs can significantly reduce the risk of fracture during the first few years of use, they have little if any benefit after three to five years. At the same time, the risks for rare but serious side effects -- including unusual fractures of the femur and bone death of the jaw -- may increase.

Indeed, consumers have voted with their feet, abandoning the drugs in droves. The number of dispensed prescriptions for bisphosphonates has plummeted to an estimated 24.7 million this year from 46.8 million in 2007, according to IMS Health, a health care information and services company, even though cheaper generic formulations have become available.

Part of the problem is that once doctors develop certain practice habits, they become ingrained and are hard to change, said Dr. H. Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and an author of "Overdiagnosed: Making People Sick in the Pursuit of Health."

And postmenopausal women represent "a huge market," Dr. Welch added. "That's a big part of the story."

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