It may not be the disease women fear most, but that's not for lack of publicity.
In the past decade, a multibillion-dollar industry has sprung up devoted to preventing, diagnosing and treating osteoporosis--thin, brittle bones that tend to fracture easily. That's remarkable for a condition most people had never heard of 15 years ago.
These days it's hard to open a magazine or turn on the television without seeing ads for prescription drugs, pitched by actresses of a certain age, aimed at combating fragile, porous bones. There are stories about the threat osteoporosis poses to aging women, next to ads that are part of the ubiquitous milk-mustache campaign. Bookstore shelves are laden with such self-help books as "The Super Calcium Counter" and "Strong Women Stay Young." Supermarkets and drugstores bulge with an expanding array of calcium-enriched foods--chewy candy supplements, breakfast cereals, bread, pancake mixes and juices, as well as over-the-counter "natural" remedies that trumpet "bone health."
The message is unequivocal: Women (and some men) need to take action to avoid developing the insidious, crippling disease that has struck an estimated 10 million Americans and can result in a hip fracture, a dowager's hump, an aching back, loss of height and death in a nursing home.
Actress Rita Moreno, 68, is the newest spokeswoman for the "Stay Strong! Test Your Bone Strength" campaign underwritten by Merck, maker of Fosamax, the world's leading osteoporosis drug. Moreno recently told Florida's Orlando Sentinel that failure to take a bone-density test is "absolutely criminal," because the noninvasive test takes only 10 minutes and can, she says, avert a dreaded disease.
"I'm all for scaring women when it comes to health," Moreno recently told the Chicago Tribune.
Just how big a threat does osteoporosis really pose to the tens of millions of female baby boomers approaching or just beyond 50, the average age of menopause, and their older sisters?
Does the difference between a vigorous, independent old age and shuffling, hunchbacked dependence in a nursing home really lie in getting a bone-density test and starting a drug as early as your late 40s in the hope of averting a broken bone 20, 30 or 40 years later?
Interviews with women's health advocates and osteoporosis experts suggest that the answers to these questions are considerably more complicated, and less clear-cut, than some public-service campaigns, calcium-supplement pitches and drug ads suggest. These skeptics acknowledge that osteoporosis is a serious and potentially devastating medical problem--one that is likely to increase in incidence and importance as more Americans live longer. But they say it has also been the subject of considerable hype and confusion fueled by drug companies and other firms pushing products and by some advocates seeking to raise awareness of their cause.
"I think even people who agree that osteoporosis is a serious public health problem can still say it's being hyped. It is hyped," said Mark Helfand, director of the Evidence-Based Practice Center at Oregon Health Sciences University in Portland. "Most of what you could do to prevent osteoporosis later in life has nothing to do with getting a test or taking a drug," added Helfand, a member of a National Institutes of Health consensus panel that spent three days in March conferring about the prevention, diagnosis and treatment of osteoporosis.
"What's troublesome about all this publicity is that osteoporosis is getting visibility out of proportion" to its significance, said Deborah Briceland-Betts, executive director of the Older Womens League, a Washington-based advocacy organization active in health education. As a result, she said, other common and equally serious health problems such as heart disease and obesity have received short shrift.
"There's a whole group of people who don't need intervention, other than advice about eliminating risk factors, which everyone should get," agreed Robert Lindsay, a New York internist and one of the founders of the National Osteoporosis Foundation.
Wyeth-Ayerst spokeswoman Audrey Ashby said the company's promotion of Prempro using pre-menopausal women is appropriate. "It's an ad that encourages women to talk to their health-care provider about estrogen loss at menopause."
Sandra C. Raymond, who was instrumental in transforming the National Osteoporosis Foundation from a small interest group that she helped launch in 1986 into a powerful advocacy organization with an annual budget of about $10 million (about 25% of it from drug companies, she said), said that osteoporosis for years suffered from a dearth of attention.