Marketing disease: is osteoporosis an example of ‘disease mongering’?

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Osteoporosis is often described as a disease, yet the symptoms are imperceptible and reliable diagnostic criteria have not been formulated. It is probably better described as a potential risk factor in patients with underlying illness. However, the marketing of osteoporosis has created the impression that all women (and many men) are at risk of suffering fragile bones, hip fracture and death. Large sums of money have been spent on raising awareness, diagnosing and treating osteoporosis, yet its link to hip fracture is not strong and the drug therapies used may be of little benefit or cause actual harm. This article draws parallels in the development of such pseudo-illness with the medicalization of the menopause and the pathologizing of a number of phenomena, including blood pressure, unhappiness, cholesterol levels, sexual and social function. Similarly, in these cases, the manufacture of 'lifestyle' drugs has been costly without significant improvement in mortality or morbidity. Indeed, as was the case with hormone replacement therapy, which resulted in the unnecessary deaths of thousands of women, there may be significant risks attached to treating non-existent diseases. The influence of the medical profession and large drug manufacturers is evaluated and their vested interest in the manufacture of illness is explained. Finally, the crucial role of nursing in challenging these shibboleths is discussed.