Medical Community Far Behind in Preventing Osteoporosis

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New guideline for physicians expected to help fill in gaps in treatment

HAS YOUR physician ever asked you whether your mother or sister suffered a bone fracture as a result of fragility rather than because of a hard fall? Has he or she counseled you to consume at least 1,200 milligrams of calcium daily? Has the doctor talked to you about achieving an appropriate level of physical activity for bone strengthening?

If you're a woman past menopause, these issues "should be coming up" during office visits, says Bess Dawson-Hughes, MD, president of the National Osteoporosis Foundation and chief of the Bone Metabolism Laboratory at Tufts's USDA Human Nutrition Research Center on Aging. But there's a good chance they're not.

Even women who have already suffered a fracture--raising the risk for a second fracture four- to seven-fold within the first year--are often not adequately advised or treated, Dr. Dawson-Hughes points out. Consider one study in which only 7 to 37 percent of patients at four different hospitals were put on bone-saving medication within a year of suffering a hip fracture, even though prescriptions in such cases are supposed to be standard treatment. In another study, only 27 percent of women with hip fractures were given appropriate medical treatment.

The statistics "have run from horrible to dismal," Dr. Dawson-Hughes says--which is why she has led the National Osteoporosis Foundation in updating its Physician's Guide to Prevention and Treatment of Osteoporosis, a 40-page booklet designed to help doctors help their patients avoid a disease that strikes one in five postmenopausal white women in the US (figures are not available for blacks or Asians). It also puts an additional one in two white women at risk because they have low bone density at the hip. Altogether, that's almost 30 million women at risk.

It's very, very serious. Up to 20 percent of people who break a hip die within a year because of complications related to the fracture. Spinal fractures can lead to problems that include everything from constipation and abdominal pain to lung disease because of changes in the trunk that affect organs there. And fractures of the hip, spine, or wrist--the most common sites for osteoporatic bone breaks--frequently lead to depression and loss of self-esteem as patients grapple with pain and unwanted changes in posture and other aspects of appearance.

Nuts and bolts of the new booklet
The new physicians' guide, because of the level of detail it provides, is meant only for doctors (who can order a single copy, free, by calling 202-223-2226). But there's a lot of information in the guide, distilled here, that patients can use to partner with their doctors to make sure they get the best preventive care and, if necessary, treatment.

Consider osteoporosis something like high blood pressure. Just as high blood pressure can't be felt and offers no obvious signs of its presence until a person suffers a heart attack or stroke, osteoporosis is a silent condition that, if undiagnosed, will only become apparent once someone suffers a potentially debilitating fracture. That's why the National Osteoporosis Foundation wants doctors to perform a bone mineral density scan on all women 65 or older and on younger postmenopausal women with one or more risk factors. These include history of fracture as an adult; history of fracture in a first degree relative due to fragility (rather than because of a high-impact hit per se); body weight less than 127 pounds; current smoking; or use of corticosteroids for more than 3 months.

Also included in the list of risk factors that would make a woman eligible for a bone scan younger than 65 are impaired vision (which could make someone more prone to falling); menopause earlier than age 45; dementia; poor health/frailty; recent falls; lifelong low calcium intake (a common problem); low physical activity; and having more than two drinks a day.

Take in at least 1,200 milligrams of calcium a day and 400 to 800 International Units of vitamin D (both with the help of supplements, if necessary). And engage regularly in weight-bearing exercises such as brisk walking (most, if not all, days of the week) and strength-training routines like lifting weights (two to three times a week); both strengthen bone.

Take measures to reduce the risk for falls by going to appropriate specialists who can check (and correct) vision and hearing; evaluate and treat neurological problems that could affect balance; and review prescription medications that could also impair balance. Patients themselves can help prevent falls at home by, say, tacking down runners or installing bathtub handles and rubber mats to keep from skidding.

Avoid excessive alcohol intake and all tobacco, both of which can weaken bone. In one study performed at Tufts, it was found that even women exposed to secondhand smoke as children had weaker bones than others.

PHOTO (BLACK & WHITE): Bess Dawson-Hughes, MD, Chief, Bone Metabolism Laboratory, Jean Mayer USDA Human Nutritional Research Center on Aging at Tufts University

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