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Thin bone threat rises for older Americans

Friday, October 15, 2004

WASHINGTON -- Half of Americans older than 50 will be at risk of fractures from too-thin bones by 2020, the surgeon general warned Thursday, urging people to get more calcium, vitamin D and exercise to avoid crippling osteoporosis.

The bone-thinning disease is on the rise as the population grays -- but weak bones aren't a natural consequence of aging, Surgeon General Richard Carmona stressed.

Strong bones begin in childhood, and years of eating right and physical activity can leave even 80-somethings with sturdy bones. Unfortunately, Carmona said, too few Americans follow that prescription, setting the stage for worrisome increases in broken hips and other fractures as more people pass their 50th birthday.

"Osteoporosis isn't just your grandmother's disease," Carmona said in releasing the first surgeon general's report on bone health. "We all need to take better care of our bones."

Osteoporosis affects an estimated 10 million Americans, and each year, about 1.5 million suffer a fracture as a result. Another 34 million Americans have less severe bone-thinning but enough to still risk a fracture.

By 2020, about 14 million people over age 50 are expected to have osteoporosis and another 47 million will have low bone mass, the report predicts.

Women are at highest risk, especially white women, and particularly after menopause when estrogen -- which also helps keep bones strong -- plummets. But osteoporosis affects men, too, and people of all races.

It's under-diagnosed because many people don't know their bones are thinning until one breaks.

But often doctors are just as guilty in overlooking the risk -- even forgetting to check bone density when middle-aged or older patients suffer fractures.

Consider hip fractures. About 20 percent of seniors who suffer one die within a year, partly because the break often triggers a downward spiral of inactivity, depression and other problems. Yet the report cited one study that found fewer than a quarter of hip-fracture patients were given calcium and vitamin D supplements to help build up their bones -- or a bone-density test to check the severity of their bone-thinning.

Bone health is a balancing act: Cells called osteoclasts dissolve old, worn-out bone while other cells called osteoblasts form new bone. Peak bone formation occurs before age 30, and then the bone-building cells can gradually slow down over the ensuing decades.

While the risk rises with age, other factors can thin bones sooner.

"I always thought I was too young," said Abby Perelman of Connecticut, who was diagnosed with osteoporosis at age 47. Her mother has it, too, and had urged Perelman -- who didn't eat much calcium or exercise -- to insist on a bone density test that her doctor hadn't thought necessary.

By 51, Perelman had her first fracture. "I am very afraid of falling," she said. "I do live with back pain almost every day."

A number of drugs treat osteoporosis, either by slowing a bone's breakdown or pushing new bone formation.

But Carmona said the main focus must be on preventing thinning bones, not on medication. "If we let it get that far, we probably missed the boat."

Among his report's recommendations:

Eat enough calcium and vitamin D starting in childhood. Recommended amounts vary by age, but the average adult under 50 needs about 1,000 milligrams of calcium and 200 international units of vitamin D each day. That rises to 1,200 mg of calcium and 400-600 IU of vitamin D over age 50.

Good calcium sources include lowfat milk or other dairy products, fortified orange juice, soybeans, salmon and broccoli. Few people absorb enough vitamin D from sunshine, but it's in fortified foods, too. Many people require supplements to get enough.

Adults need at least 30 minutes of physical activity a day, and children 60 minutes, including weight-bearing activities that improve bone strength and balance.

All women over 65 -- and any man or women who suffers even a minor fracture after age 50 -- needs a bone-density test.

Doctors should look for other warning signs, including people under 50 who have had multiple fractures, or take steroid-containing medications or have hormonal or other diseases that can thin bones.

Older people should minimize the risk of falls by removing items they might trip over, improving lighting, and getting their vision checked.


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