- Here are some curious facts about bones. They can tell us about the kinds of physical labor an individual has performed over a lifetime and about sustained physical trauma. They get thinner or thicker (on average in a population) in different historical periods and in response to different colonial regimes (Molleson 1994; Larsen 1998). They can indicate class, race, and sex (or is it gender — wait and see). We can measure their mineral density and whether on average someone is likely to fracture a limb but not whether a particular individual with a particular density will do so. A bone may break more easily even when its mineral density remains constant (Peacock et al. 20021).
- Culture shapes bones. For example, urban ultraorthodox Jewish adolescents have lowered physical activity, less exposure to sunlight, and drink less milk than their more secular counterparts. They also have greatly decreased mineral density in the vertebrae of their lower backs, that is, the lumbar vertebrae (Taha et al. 2001). Chinese women who work daily in the ﬁelds have increased bone mineral content and density. The degree of increase correlates with the amount of time spent in physical activity (Hu et al. 1994); weightlessness in space ﬂight leads to bone loss (Skerry 2000); gymnastics training in young women ages seventeen to twentyseven correlates with increased bone density despite bone resorption caused by total lack of menstruation (Robinson et al. 1995). Consider also some recent demographic trends: in Europe during the past thirty years, the number of vertebral fractures has increased three- to fourfold for women and more than fourfold for men (Mosekilde 2000); in some groups the relative proportions of different parts of the skeleton have changed in recent generations. (See also table 12.)
- What are we to make of reports that African Americans have greater peak bone densities than Caucasian3 Americans (Aloia et al. 1996; Gilsanz et al. 1998), although this difference may not hold when one compares Africans to British Caucasians (Dibba et al. 1999), or that white women and white men break their hips more often than black women and black men (Kellie and Brody 19904)? How do we interpret reports that Caucasian men have a lifetime fracture risk of 13–25 percent compared with Caucasian women’s lifetime risk of 50 percent even though once peak bone mass is attained men and women lose bone at the same rate (Seeman 1997, 1998; NIH Consensus Statement Online 2000)?
- Such curious facts raise perplexing questions. Why have bones become more breakable in certain populations? What does it mean to say that a lifestyle behaviour such as exercise, diet, drinking, or smoking is a risk factor for osteoporosis? Why do we screen large numbers of women for bone density even though this information does not tell us whether an individual woman will break a bone5? Why was a major public policy statement on women’s health unable to offer a coherent account of sex (or is it gender?) differences in bone health over the life cycle (Wizemann and Pardue 2001)? Why, if bone fragility is so often considered to be a sex-related trait, do so few studies examine the relationships among childbirth, lactation, and bone development (Sowers 1996; Glock, Shanahan, and McGowan 2000)?
- Such curious facts and perplexing questions challenge both feminist and biomedical theory. If “facts” about biology and “facts” about culture are all in a muddle, perhaps the nature/nurture dualism, a mainstay of feminist theory, is not working as it should. Perhaps, too, parsing medical problems into biological (or genetic or hormonal) components in opposition to cultural or lifestyle factors has outlived its usefulness for biomedical theory. I propose that already well-developed dynamic systems theories can provide a better understanding of how social categories act on bone production. Such a framework, especially if it borrows from a second analytic trend called “life course analysis of chronic disease epidemiology” (Kuh and Ben-Shlomo 1997; Ben-Shlomo and Kuh 2002; Kuh and Hardy 2002), can improve our approaches to public health policy, prediction of individual health conditions, and the treatment of individuals with unhealthy bones. To see why we should follow new roads, I consider gender, examining where we — feminist theorists and medical scientists — have recently been. In the second part of this study (Fausto-Sterling in preparation) I will engage with current discussions of biology, race, and medicine to explore claims about racial difference in bone structure and function.
Cited by "Davies (Sally) - Women’s minds matter".
- Munro Peacock et al. write: “The pathogenesis of a fragility fracture almost always involves trauma and is not necessarily associated with reduced bone mass. Thus, fragility fracture should neither be used synonymously nor interchangeably as a phenotype for osteoporosis” (2002, 303).
- For example, sitting height reﬂects trunk length (vertebral height) vs. standing height, which reﬂects the length of the leg bones. These can change independently of one another. Thus height increases can result from changes in long bone length, vertebral height, or both. See Meredith 1978; Tanner et al. 1982; Malina, Brown, and Zavaleta 1987; Balthazart, Tlemcani, and Ball 1996; Seeman 1997.
- The use of racial terms such as Caucasian and others in this article is fraught. But for the duration of this article I will use the terms as they appear in the sources I cite, leaving an analysis of this problematic terminology to future publications, e.g., Fausto-Sterling 2004.
- Since a number of studies show no sex difference in hip fracture incidence between African American men and women, the “well-known” gender difference in bone fragility may really only be about white women. As so often happens, the word gender excludes women of color (Farmer et al. 1984).
- Peacock et al. write, “Key bone phenotypes involved in fracture risk relate not only to bone mass but also to bone structure, bone loss, and possibly bone turnover” (2002, 306).
Text Colour Conventions (see disclaimer)
- Blue: Text by me; © Theo Todman, 2019
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