Aging Bones: A Short History of Osteoporosis

305 Pages·2014·1.634 MB·English

by  Gerald N Grob

AGING BONES
JOHNS HOPKINS BIOGRAPHIES OF DISEASE
Charles E. Rosenberg, Series Editor
Randall M. Packard, The Making of a Tropical Disease:
A Short History of Malaria
Steven J. Peitzman, Dropsy, Dialysis, Transplant:
A Short History of Failing Kidneys
David Healy, Mania: A Short History of Bipolar Disorder
Susan D. Jones, Death in a Small Package:
A Short History of Anthrax
Allan V. Horwitz, Anxiety: A Short History
Diane B. Paul and Jeffrey P. Brosco, The PKU Paradox:
A Short History of a Genetic Disease
Gerald N. Grob, Aging Bones: A Short History of Osteoporosis
Aging Bones
F F F
A Short History of Osteoporosis
Gerald N. Grob

Johns Hopkins University Press
Baltimore
© 2014 Johns Hopkins University Press
All rights reserved. Published 2014
Printed in the United States of America on acid-free paper
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Library of Congress Cataloging-in-Publication Data
Grob, Gerald N., 1931–
Aging bones : a short history of osteoporosis / Gerald N. Grob.
p. ; cm. — (Johns Hopkins biographies of disease)
Includes bibliographical references and index.
isbn 978-1-4214-1318-1 (pbk. : alk. paper) — isbn 1-4214-1318-3 (pbk. : alk. paper) —
isbn 978-1-4214-1319-8 (electronic) — isbn 1-4214-1319-1 (electronic)
I. Title. II. Series: Johns Hopkins biographies of disease.
[dnlm: 1. Osteoporosis—history—United States. we 11 aa1]
rc931.o73
616.7'16—dc23 2013028969
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CONTENTS
Foreword, by Charles E. Rosenberg vii
Preface xiii
List of Abbreviations xix
Chapter 1. History and Demography 1
Chapter 2. The Origins of a Diagnosis 24
Chapter 3. The Transformation of
Osteoporosis 54
Chapter 4. Popularizing a Diagnosis 86
Chapter 5. Internationalizing Osteoporosis 120
Chapter 6. Therapeutic Expansion 147
Chapter 7. Osteoporosis Triumphant? 177
Notes 231
Index 275
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FOREWORD
Disease is a fundamental aspect of the human condition. Ancient
bones tell us that pathological processes are older than human-
kind’s written records, and sickness and death still confound us.
We have not banished pain, disability, or the fear of death, even
if, on the average, we die at older ages, of chronic and not acute
ills, in hospital or hospice beds and not in our own homes. Dis-
ease is something men and women feel. It is experienced in our
bodies—but also in our minds and emotions. It can bring pain
and incapacity and hinder us at work and in meeting family re-
sponsibilities. Disease demands explanations; we think about it
and ask questions when affected by it. Why have I become ill?
And why now? How is my body different in sickness from its
quiet and unobtrusive functioning in health? Why, when an epi-
demic rages, has a community been scourged?
Answers to such ageless questions necessarily mirror and ex-
press time- and place-specific ideas, social assumptions, and tech-
nological options. In this sense, disease has always been a social
and linguistic entity, a cultural as well as a biological one. In the
Hippocratic era, more than two thousand years ago, physicians—
and we have always had them with us—were limited to the evi-
dence of their senses in diagnosing a fever, a gradual wasting, an
abnormal discharge, or seizures. Their notions of the material
basis for such felt and visible symptoms necessarily reflected and
incorporated then-prevalent philosophical and physiological no-
tions, a speculative world of disordered humors, “breath,” and
pathogenic local environments. Today we can call on a rather dif-
ferent variety of scientific understandings and an armory of diag-
nostic practices—tools that allow us to diagnose ailments not felt
by patients and imperceptible to a doctor’s unaided senses. In the
vii
viii Foreword
past century, disease has also increasingly become a bureaucratic
phenomenon, since sickness has been defined (and in that sense
constituted) by formal disease classifications, screening practices,
treatment protocols, and laboratory thresholds.
Sickness is also linked to climatic and geographic factors.
How and where we live and how we distribute our resources all
contribute to the incidence of disease. For example, ailments such
as typhus, plague, malaria, dengue, and yellow fever reflect spe-
cific environments that we have shared with our insect contem-
poraries. But humankind’s physical circumstances are determined
in part by culture and climate—and especially by agricultural
practices in the millennia before the growth of cities and indus-
try. Environment, demography, economic circumstances, and ap-
plied medical knowledge all interact to create distinctly mapped
distributions of disease at particular places and specific moments
in time. The twenty-first-century ecology of sickness in the devel-
oped world is marked, for instance, by the dominance of chronic
and degenerative illness—kidney and cardiovascular-system ail-
ments, and cancer. What we eat and the work we do or do not
do—our physical as well as our cultural environment—all help
determine our health and longevity.
Disease is historically as well as ecologically specific. Or per-
haps I should say that every disease has a unique past. Once dis-
cerned and named, every disease claims its own history. At the
primary level, biology creates that identity. Symptoms and epide-
miology, generation-specific cultural values, and scientific under-
standing all shape our responses to illness. Some writers may have
romanticized tuberculosis—think of Greta Garbo as Camille—
but, as the distinguished medical historian Owsei Temkin noted
dryly, no one has ever thought to romanticize dysentery. Tuber-
culosis was pervasive in nineteenth-century Europe and North
America and killed far more women and men than cholera did,
but the former contagion never mobilized the same widespread
and policy-shifting anxiety as the latter. Tuberculosis was a fa-
miliar aspect of life—to be endured if not precisely accepted.
Unlike tuberculosis, cholera killed quickly and dramatically and
Foreword ix
was never accepted as a condition of life in Europe and North
America. Its episodic visits were anticipated with fear. Sporadic
cases of influenza are normally invisible, remaining indistinguish-
able among a variety of respiratory infections; waves of epidemic
flu are all too visible. Syphilis and other sexually transmitted dis-
eases, to cite another example, have had a peculiar and morally
inflected attitudinal history. Some maladies, such as smallpox or
malaria, have a long history; others, like AIDS, a rather short one.
Some, like diabetes and cardiovascular disease, have flourished in
modern circumstances; others reflect the realities of an earlier and
economically less-developed world.
These arguments constitute the logic motivating and underly-
ing Johns Hopkins Biographies of Disease. “Biography” implies
an identity, a chronology, and a narrative—a movement in and
through time. Once each disease entity is inscribed by name in
our collective understanding of medicine and the body, it be-
comes a part of that collective understanding, and thus inevitably
shapes the way in which individual men and women think about
the symptoms they experience and their future health prospects.
Each historically visible entity—each disease—has a distinct his-
tory, even if that history is not always coterminous with entities
familiar to twenty-first-century physicians. The very notion of
specific disease entities—fixed and based on a defining mecha-
nism—is a historical artifact in itself. Dropsy and Bright’s disease
are no longer terms in everyday clinical practice, but they are an
unavoidable part of the history of chronic kidney disease. Nor do
we speak today of essential, continued, bilious, and remittent fe-
vers as meaningful categories. Fever is now a symptom, the body’s
physiological response to a triggering circumstance. It is no lon-
ger a disease, as it had been through millennia of human history.
“Flux,” or diarrhea, is similarly no longer an entity, but a symp-
tom associated with a variety of specific and non-specific causes.
We have come to assume there will be a diagnosis when we feel
pain or suffer incapacity—we expect the world of medicine to at
once categorize, explain, and predict ailments.
But today’s diagnostic categories are not always sharp edged