Aging Bones: A Short History of Osteoporosis

Chapter Three. The Transformation of Osteoporosis

CHAPTER THREE The Transformation of Osteoporosis F F F Concerns with the diagnostic category of osteoporosis grew, and even accelerated, as the decades passed, which was reflected in the number of published articles on this topic. Articles listed under the heading “osteoporosis (limited to English)” in PubMed in the 1960s numbered 846. A decade later they had risen to 1,570, and during the 1980s the quantity again doubled, to 3,119. In the 1990s no fewer than 9,509 articles appeared, with a leap to 22,387 in the first decade of the twenty-first century. To Fuller Albright, postmenopausal osteoporosis was a condition that affected a very small group of women. During and after the 1970s, the boundaries of osteoporosis underwent a dramatic transformation and began to include millions of women. Elevating osteoporosis to the status of a major public health problem was a process driven less by new medical discoveries than by a variety of social, cultural, and economic factors. By the late twentieth century the development of antibiotics and other drugs, the rapid expansion of biomedical knowledge, and the introduction of new technologies all combined to reshape both the theory and practice of medicine. An impression of irresistible progress was created . Sickness and disability were no longer perceived as inevitable consequences of life; they now represented problems to be con54 The Transformation of Osteoporosis 55 quered by scientific and medical advances. The gospel of health was spread by print journalism and television. Both conveyed a simple and attractive message: disease could be conquered if suf- ficient resources were devoted to research and health care. Scientific discovery, according to members of President Harry S. Truman’s Scientific Research Board, was “the basis for our progress against poverty and disease.” “The challenge of our times,” board members added, “is to advance as rapidly as possible the understanding of diseases that still resist the skills of science, to find new and better ways of dealing with diseases for which some therapies are known, and to put this new knowledge effectively to work.”1 This rising faith in the redemptive authority of medicine occurred as the structure of the American population was undergoing profound demographic changes. The decline in infant and child mortality in the late nineteenth and early twentieth centuries meant that more and more people survived into later life. Between 1900 and 1995, the number of Americans age 60 and over increased from 6 to 17 percent of the population. In 1995, over 43 million Americans (out of a total population of 262.8 million) were 60 or older, and 3.8 million were in the “very old” category (currently defined as those over 85). Before 1900, the mortality rate was the measure of health; thereafter, lifetime morbidity assumed an equal position. Chronic and long-term illnesses replaced infectious diseases as the major causes of death. Such demographic changes had significant social, economic, and political implications. The aged began to coalesce into a signi ficant bloc, with their own interests and agenda. They rejected the prevailing concept that aging and decrepitude went hand in hand. Robert N. Butler (a key figure in modern gerontology and first director of the National Institute on Aging from 1975 to 1982) referred to ageism as simply another form of bigotry. Ageism, he wrote in 1969, “reflects a deep-seated uneasiness on the part of the young and middle-aged—a personal revulsion to and distaste for growing old, disease, disability, and fear of powerlessness, ‘uselessness ,’ and death.”2 Butler rejected the view that senility followed aging and instead attributed it to disease. 56 Aging Bones The traditional concept that aging was synonymous with decline and a loss of function was slowly but surely modified by a belief that aging and disease, though obviously related, involved two distinct processes. Although aging was inevitable, many aspects of aging could be addressed in ways that minimized a loss of function and expanded healthy years. Cataract surgery, hip and joint replacements, and control of systolic hypertension were but some of the therapies that contributed to the maintenance of function and an increase in longevity. The medical profession indisputably helped alleviate diseases and disabilities associated with aging. The traditional emphasis on treatment, however, was augmented by the belief that medicine also possessed the capacity to overcome allegedly undesirable traits and prevent disease. Novel interventions seemingly could improve...