JUST A few years back, it was heresy to suggest that, when it comes to protecting bones, early treatment may not be the answer.
Part of the rite of passage through menopause a decade ago became bone-density screening. Around age 50, many women would position their skeletons under the X-ray eye of new machines that could calibrate the alarming rate at which their bones were being eaten away. On top of that, they began to hear commercials featuring women, often much younger than they, praising a pill for saving them from nursing homes, physical deterioration and crumbling spines.
FOR THE RECORD:
Osteoporosis: In Monday's Health section, an article on osteoporosis and drugs known as bisphosphonates incorrectly said that the original treatments required patients to eat before taking the drugs. In fact, originally —as now -- the daily form of the drugs should be taken on an empty stomach first thing in the morning with a full glass of water -- not juice or coffee.
It was no longer sufficient to get enough calcium and vitamin D and do weight-bearing exercise. Suddenly, there were drugs available, Fosamax being the first in 1995 of a class called bisphosphonates, that could put that lost bone density back, help prevent painful, even deadly, fractures and reduce the number of women going through old age with crooked backs.
A combination of new technology and clever marketing was pushing fear of fractures from geriatric reality to midlife worry. Meanwhile, women were hit with a new word, osteopenia, which sounds like a fearsome disease. The pre-osteoporosis, non-disease condition, named by the World Health Organization in 1992, has a broad enough definition to include about half of all women over 50. "The average bone density for a 60-year-old Caucasian woman would put her in osteopenia," says Dennis Black, an epidemiologist at UC San Francisco who studies the effectiveness of osteoporosis treatments.
Confused about what the new label actually meant, young, healthy women suddenly seemed more worried about their bones than did their mothers and grandmothers -- who really had something to worry about. "Women don't understand what their risk is, one way or the other," says Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center of Columbia University Medical Center in New York.