| CAStinneford 2004-10-25, 7:08 am |
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An article in the Science section of The New York Times this morning.
http://www.nytimes.com/2004/10/19/h...ogin&pagewanted
=print&position=
The New York Times
October 19, 2004
The (Often Neglected) Basics for Keeping Bones Healthy
By GINA KOLATA
In surveys and focus groups, most Americans say they know what to do to protect
themselves against osteoporosis, the disease of fragile bones that often occurs
in the elderly: eat lots of calcium-rich foods or take a calcium supplement.
Many say they are doing just that, or plan to.
But this response worries osteoporosis researchers like Dr. Joan McGowan, chief
of the musculoskeletal diseases branch at the National Institute of Arthritis
and Musculoskeletal and Skin Diseases.
Consuming calcium, she and others note, can at best make a small difference in
osteoporosis risk, while other methods that can have a more substantial effect
are often ignored.
Dr. McGowan is one of two scientific editors of the surgeon general's report on
bone health that was released last week. The report has an ambitious goal: to
educate doctors and the public so that they can put into practice what
researchers know about preventing and detecting the bone disease.
The lack of this knowledge, Dr. McGowan said, often leads to bad practice.
For example, she said, doctors should routinely evaluate people over 50 who
break a bone, for any reason, to see if they have osteoporosis. But such
evaluations are seldom ordered.
Doctors should also make sure that older people get enough vitamin D, because
deficiencies greatly increase fracture risk, Dr. McGowan said. But this, too,
is rarely done.
Osteoporosis, the most common bone disease, is grimly serious, afflicting 10
million Americans over age 50 annually.
Each year, the report found, about 1.5 million Americans break bones because of
osteoporosis, costing the health care system $18 billion. Often, the bone that
is broken is the hip. And a hip fracture can set off a spiral leading to a
nursing home and death: 20 percent of people who break a hip die within a year,
the report said.
Osteoporosis can be prevented and treated with drugs that keep bones from
breaking down - if people realize that they have it.
The report urges that doctors and patients pay attention to bones throughout
life. Children and adolescents need a proper diet and exercise to stimulate
bone growth. For adults, eating properly and staying active can maintain bone
strength.
The report recommends that people over 50 who are at high risk for osteoporosis
- women with a strong family history of the disease, for example - and anyone
over 65 have a bone density test. Older people should also take simple measures
to prevent falls, like removing small rugs from their homes.
But paying close attention to fractures is near the top of most experts' list
of largely ignored medical interventions.
"When you see people over 50 who fall and break a wrist bone, you need to stop
and take a look," said Dr. Richard H. Carmona, the surgeon general. "We need to
take one step back and say, 'Why should that bone have broken from a simple
fall?' "
That advice is not just for broken wrist bones, Dr. McGowan added.
"One of the ideas that people have is that you earned your fracture," she said.
"You tripped, or you were ice skating with your granddaughter and you fell and
broke your arm. Well, how many times did your granddaughter fall and not break
an arm?"
Dr. McGowan said that a fracture was "really a sentinel event in an older
person - any fracture."
"I don't care if you got it falling off a bike or even in a traffic accident,"
she continued.
Yet too often, she said, doctors do not send patients with broken bones to be
evaluated to see why the bone broke in the first place.
The American Academy of Orthopaedic Surgeons agrees.
In a position statement last year, it urged members to do more than just repair
fractures in older people.
"There is a terrific information gap," said Dr. Laura Tosi, an orthopedic
surgeon at George Washington university and a member of the academy's board.
"Orthopods know how to put metal in and get people up and going, but if you
don't prevent future fractures, people will end up disabled."
It is not just orthopedists who often miss opportunities. In a paper published
last year in The Journal of Clinical Endocrinology & Metabolism, Dr. Ethel
Siris, director of the Toni Stabile Osteoporosis Center at New
York-Presbyterian Hospital/Columbia university Medical Center in New York, and
her colleagues reviewed the data and found it depressing.
"In virtually all the reports that have been published in the past few years,
physicians who deal directly with the fracture event rarely take appropriate
action," they wrote. "This includes radiologists who review X-rays that include
the spine, orthopedic surgeons who treat acute fractures, physiatrists who
oversee rehabilitation after the fracture, and primary care physicians to whom
the patients return for overall care once the fracture has healed."
For example, in one study reviewed in the paper, of 934 women over age 60 who
had routine chest X-rays, 132 had visible moderate to severe vertebral
fractures. But only 17 of them had these fractures noted on their discharge
statements.
Another underappreciated problem, osteoporosis experts say, is a lack of
vitamin D, which bones need to absorb calcium and phosphorus. Vitamin D
deficiencies greatly increase the risk of fractures. Yet a new national study
by Dr. Michael Holick of Boston University, of about 1,500 postmenopausal women
with osteoporosis, found that half had vitamin D levels below what is
considered ideal.
Vitamin D is made in the skin in response to sun exposure, but many people do
not get enough sunlight, Dr. Siris said, noting that there is a concern about
skin cancer. "People today are sun-averse," she said. "And in the elderly, who
don't go outdoors, this is a real issue."
She added that the deficiency was easily corrected by vitamin D supplements
that cost as little as $3.40 for 100 pills.
Osteoporosis is a real problem, Dr. Siris said. "This is not something made up
by the pharmaceutical industry."
But for people who are worried about ending their days bent over with the
disease, or with a broken hip in a nursing home, Dr. Carmona has a message.
"You don't have to be a hunched over old lady or old man," he said. "If you pay
attention to bone health."
Copyright 2004 The New York Times Company |
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