More must be done about osteoporosis, surgeon general says

Bone-thinning disease threatens 34 million as U.S. baby boomers age

The Nation

October 15, 2004|By David Kohn | David Kohn,SUN STAFF

Warning that 34 million Americans are at risk of developing osteoporosis, the surgeon general has asked doctors and the public to take the degenerative bone disease more seriously.

"We have a problem with bone health in the United States, and much of it is preventable," Surgeon General Richard H. Carmona said yesterday.

With millions of aging baby boomers ready to join the at-risk population, Carmona said, the public - and many medical practitioners - remain ignorant about the disease, which affects 10 million Americans, 80 percent of them women.

More than two-thirds of women with the disease have not been diagnosed yet, said Dr. Redonda Miller, an internist and osteoporosis specialist at Johns Hopkins Hospital. Miller did not work on the report that sparked Carmona's remarks.

"Because we're living longer, this is becoming a bigger problem," she said.

Osteoporosis is a structural deterioration of bone tissue that greatly increases the risk of fractures. The report estimated that the disease is responsible for 1.5 million fractures a year, at a total cost of $14 billion.

The report, the surgeon general's first on osteoporosis, predicted that by 2020, half of Americans over 50 will have or be at risk for the disease.

"These numbers are going to grow as baby boomers age," said one of the report's authors, Dr. Anna Tosteson, a professor at Dartmouth Medical School and one of more than 100 experts who helped craft the document over 2 1/2 years.

"This report is a milestone in the field of osteoporosis and bone health," said Dr. Bess Dawson-Hughes, president of the National Osteoporosis Foundation.

Researchers emphasized that osteoporosis can have fatal consequences. It contributes to 300,000 hip fractures a year, and 20 percent of those victims die within a year of their accidents.

Miller and other experts welcomed the report, saying it would increase awareness of the disease. "It has not been a priority for the health care system, and it should be," she said.

The report did not present new research. Rather it compiled recent advances and made recommendations for improving prevention and treatment. "This is a disease process that is preventable," said Carmona.

Preventive measures include getting enough calcium and vitamin D in the diet and participating in a regular program of weight-bearing exercise. Smoking and drinking alcohol decrease bone mass and should be avoided, experts say.

Adults reach maximum bone density about the age of 30, researchers say. After that, bone mass stabilizes for several years and then decreases. After menopause, women's bone density decreases rapidly, and the disease is especially common in women over 65.

The report focused on the need to educate doctors about osteoporosis. "They assume it's part of aging," said Duke University medical sociologist Deborah Gold, one of the authors. "It isn't. It's a disease."

Gold, who studies the social consequences of osteoporosis, suspects that sexism among male doctors plays a part.

She said that many people don't understand how devastating the disease can be: In severe cases, bones become so weak that a simple cough can cause a spinal fracture. Those with the disease have high rates of depression, anxiety and social isolation.

But in recent years, doctors have improved diagnosis, prevention strategies and treatment. One tool is the bone mineral density test, a noninvasive X-ray that determines bone mass.

Before the test became common over the past decade, doctors had no way to diagnose the disease until it advanced to the point where it produced fractures.

"It's pretty widely available, and it's covered by Medicare," said study co-author Dennis Black, an epidemiologist at the University of California, San Francisco.

The disease is easier to treat now, too, experts say. In the past, women at risk for the disease often took estrogen, which slows bone loss. But recent studies have shown that estrogen use can also increase a woman's risk of heart attack and stroke.

Over the past seven years, doctors have increasingly used a class of drugs, bisphosphonates, which inhibit bone loss with fewer side effects. Researchers are now testing versions that would allow doses to be given once a month, or even once a year, according to Black. And a drug introduced last year, Forteo, can increase bone formation.

To read the complete text of the surgeon general's report on osteoporosis, visit www.baltimoresun.com/osteoporosis.

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