UBC Faculty Research and Publications

Normal bone mass, aging bodies, marketing of fear : bone mineral density screening of well women Kazanjian, Arminée, 1947-; Green, C. J. (Carolyn Joanne), 1956-; Bassett, Kenneth, 1952-


Definitions of osteoporosis have become increasingly dependent on bone mineral density (BMD) measures. However, there are major limitations with this type of approach which promotes a medical reductionist perspective, contributes to the medicalization of normally aging women, and supports technological determinism. This paper takes a critical approach to needs assessment. It examines the various interests being served through unchecked use of a diagnostic technology, and asks: ‘who needs this technological service?’. Despite mounting evidence that BMD measures have a very low positive predictive value, entire cohorts of middle-aged and older women are labelled with their BMD measures. This is done for the sake of “early detection” and “better management” of “endocrine deficiency disorder”. The medicalization of yet another transition in the lives of women conforms to the bio-medical model and serves many private interests. Beyond the labelling of entire cohorts, the early (and hence of necessity, repeated) use of this technology is being presented as the only hope for preventing bone fractures. The paper discusses serious ethical challenges in public health which remain to be identified and addressed. It is concluded that the recently heightened profile of women’s health issues, such as osteoporosis, is based more on economic premises than on sound evidence from technology assessment. When the evidence on effectiveness clearly does not support current patterns of diffusion, a critical approach to needs-based health technology assessment is required so as to provide a broader perspective within which power relations and private interests can better be understood.

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