Osteoporosis is a Feminist Issue! (Guest Post)

azarIn the past two years, since I started my PhD studies, my research has focused on osteoporosis and how modifiable exercise programs can prevent or slow down its progression. A requirement for PhD, before starting the actual thesis phase, is writing a literature review. Rading a high volume of research articles (up to 400-500) for a critical synthesis of literature would be the most daunting part. However, the review of literature helps the students to identify the strengths, weaknesses and gaps in previous work related to their own topic as a base.

Being at this stage, I read about osteoporosis from different angles to learn about facts, myths and contradictions.

To me, it has been very interesting to read about osteoporosis and how sex and gender differences attributed to bone structure can be addressed through a feminism lens.

So, apart from expanding my overall knowledge on osteoporosis, its symptoms, causes and treatment and assessing exercise programs, I have noticed remarkable feminism involvements in the language of research studies.

Let me start with some statistical facts on osteoporosis:

  • Of the millions who are diagnosed or at risk for osteoporosis, 80% are women.
  • Osteoporosis affects 1 in 4 women and 1 in 8 men over the age of 50 years in Canada.
  • Approximately one in two women over age 50 will break a bone because of osteoporosis.
  • Lowered estrogen levels in postmenopausal women leads to osteoporosis.
  • A woman’s risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer.
  • Women sustain more falls and fractures than men.

And, just by a simple search in PubMed database, entering the keywords “osteoporosis AND postmenopausal women” gives you a list of 11,104 articles while changing keywords to “osteoporosis AND elderly men”, narrows the number of articles down to 344. (it is not an advanced search, I just wanted to give you a comparison between number of studies in women and men)

Also, the figure below might help you to visualize the difference in sex and age prevalence of osteoporosis. As you see, the figure shows the age-adjusted prevalence of osteoporosis at femur neck and lumbar spine 16% in women compared with 4% in men. Also, the ratio of bone density loss at either site is 61% in women versus 38% in men.

Osteoporosis & low bone mass at the femur neck or lumbar spine, by sex in adults aged 50 years & over

Osteoporosis & low bone mass at the femur neck or lumbar spine, by sex in adults aged 50 years & over

Source: CDC/NCHS, National Health and Nutrition Examination Survey, 2005–2008

Now, imagine you are a woman (like myself), at the threshold of menopause, and have to read 50-100 pages about osteoporosis on average each day. How would it be? More probably, you think that you are at higher risk for developing osteoporosis because you are a woman. Or, you are at higher risk for falls and as a result, you have more fractures because you are a woman. You lose bone faster than men. So, being a pre or postmenopausal woman puts you at higher risk of broken bones. And not fun to conclude that, osteoporosis is just a “feminine disease” and a welcome gift for you who put your feet in the new world of menopause!

Fortunately, being a feminist reader and exposed to a large volume of osteoporosis research articles, I have noticed that something is changing from the oldest to the newest articles. and that something is the “bias in the language” used by the researchers. Although the language of many articles still needs sweeping revision.

But, not all my news about osteoporosis is bad news!

Looking into osteoporosis and searching through a feminism lens opens new door to the research world and I tell you how.

Recently, I read about a new research project called “Gender Innovations”. Gender Innovations is a peer-reviewed project initiated at Stanford University in June 2009, and aimed at developing practical methods of sex and gender analysis for scientists and researchers. Londa Schiebinger, the leader of this project is a pioneer in research on gender and science. She is well known for her writings on the impacts of feminism in the field of science.

In a case study called “Osteoporosis Research in Men”, she states that sex and gender analysis includes men in osteoporosis research, for having a better diagnosis and treatments. She states that osteoporosis had primarily been considered a disease of postmenopausal women, and as a result, this assumption has shaped its screening, practice, diagnosis, and treatment. She believes that more work is needed to “redefine diagnostic cutoffs” for both osteoporotic women and men.

See the link below for more information:

http://genderedinnovations.edu/case-studies/osteoprosis.html

So, based on what I have learned so far, this would be my argument:

There is a need for a feminist framework in osteoporosis studies, where osteoporosis re-definition would reveal the reality that risk factors are pretty much the same for women and men. For example, factors such as family history (genetics), taking steroid medications, sedentary lifestyle, smoking and drinking too much alcohol can increase or decrease the risk of osteoporosis in women and men. Or, malnutrition, deficiency in vitamin D and calcium intake can be risk factors of getting osteoporosis in women and men.

In addition, highlighting osteoporosis as a female disease can lead to a neglect and underestimation of this disease in the men population, specifically, the elderly men. This is another aspect lying beneath of many biased research findings and conclusions. So, it is really important to emphasize the fact that osteoporosis is not just a woman’s disease.

bones3

Of a more positive note, research proved that osteoporosis can be prevented and that exercise plays an important role in its prevention. Whether or not you have osteoporosis, whether you are a woman or man, regular exercise is beneficial in so many ways. Exercise improves physical and mental health, functional mobility, balance, strength and quality of life. People, who exercise regularly, can manage osteoporosis much better. Weight bearing exercises, resistance training, flexibility and balance exercises like Pilates, Tai Chi and yoga are good examples of dealing with osteoporosis. Higher impact activities like running, jumping and jogging are proved to be effective. However, they might not be suitable for everyone.

See Sam’s blog post: Keeping bones strong

And last but not least, be happy if you are not thin. Studies show that small boned women are at greater risk for osteoporosis and it does not seem to be a myth!

I am a second year doctoral student in the Health and Rehabilitation Sciences at the Western University, and a certified seniors’ fitness instructor with so much passion about the elderly women’s health and fitness. Besides that, I am a grandmother and a full time babysitter of an almost 2 year-old awesome grandson. Being physically active has been integrated into my busy life since my youth. I used to be a strength coach, so that weight training is my first priority but running, mountain biking, rollerblading, ice skating and yoga are activities that I love to do.