Summary of Council decision:

Two issues were investigated, both of which were Not upheld.

Ad description

A direct mailing, for a health screening service, included a leaflet headed "Now you can plan for your future. At last there's a quick, convenient way to check your risk of Stroke, Heart Disease and Osteoporosis". Inside the leaflet was a section headed "Your Questions Answered". In response to the question "I already have a doctor. Why do I need Life Line Screening?", text stated "GPs will only recommend you for tests if you show symptoms of a disease. However, stroke, vascular disease and osteoporosis are considered 'silent killers'. They can strike with no previous symptoms".


The complainant challenged whether the claim that osteoporosis was a "silent killer"

1. was misleading, and

2. could cause fear without justifiable reason.


1. & 2. Life Line Screening UK Ltd (LLS) said osteoporosis was regularly called a silent killer. They said there were often no warning signs for osteoporosis until someone experienced a fracture, often after a minor fall, and hip fractures, which were one of the common types of fracture caused by osteoporosis, were often followed by death. National statistics showed that on average, 24% of hip fracture patients died within one year of fracture. They added that osteoporosis was considered a serious chronic disease similar to cardiovascular disease. They provided links to online newspaper articles, information on the websites of osteoporosis organisations and studies into osteoporosis in support of the claim and the hip fracture mortality statistic.


1. Not upheld

The ASA noted the claim that osteoporosis was a "silent killer" was immediately followed by the claim that it could "strike with no previous symptoms". We considered readers would therefore understand the claim to mean that people could suffer a fracture due to osteoporosis without previously being aware they had the disease, and that such a fracture carried an increased risk of death.

We understood that there were no warning signs for osteoporosis until a fracture occurred, which was why it was variously described as a "silent killer", a "silent disease" and a "silent epidemic" in the articles on newspaper and osteoporosis organisation websites referenced by LLS. The majority of the documents, including the studies provided by LLS, referred to an increased risk of death after a hip fracture. The sources referenced differing percentage rates of increased risk, but we noted there was a consensus in the medical literature, and amongst osteoporosis organisations, that hip fractures were one of the three most common osteoporotic fracture sites, and that sustaining a hip fracture carried a significantly increased risk of death. Given that a fracture was often the first sign that a person had osteoporosis, and that hip fractures carried an increased risk of death, we considered it was reasonable to describe osteoporosis as a "silent killer". We concluded the claim was not misleading.

On this point, we investigated the ad under CAP Code (Edition 12) rules  3.1 3.1 Marketing communications must not materially mislead or be likely to do so.  (Misleading advertising) and  3.7 3.7 Before distributing or submitting a marketing communication for publication, marketers must hold documentary evidence to prove claims that consumers are likely to regard as objective and that are capable of objective substantiation. The ASA may regard claims as misleading in the absence of adequate substantiation.  (Substantiation), but did not find it in breach.

2. Not upheld

We noted the claim also referred to stroke and vascular disease, which were conditions that were more commonly known by the general public to be associated with sudden, life-threatening health incidents which occurred with little or no warning. We considered the advertiser's association of osteoporosis with stroke and vascular disease might therefore cause fear to some readers who were unaware of the life-threatening risks of an osteoporotic hip fracture. Nonetheless, because we had seen evidence that osteoporosis could reasonably be described as a "silent killer", we concluded that the claim was unlikely to cause fear without justifiable reason.

On this point, we investigated the ad under CAP Code (Edition 12) rule  4.2 4.2 Marketing communications must not cause fear or distress without justifiable reason; if it can be justified, the fear or distress should not be excessive. Marketers must not use a shocking claim or image merely to attract attention.  (Harm and offence), but did not find it in breach.


No further action necessary.

CAP Code (Edition 12)

3.1     3.7     4.2    

More on