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Osteoporosis: Are we too dense about thin bones? Disease can be warded off with diet and exercise. So why do so few women know how to prevent it? Tuesday, April 28, 1998 By Ellen Mazo, Post-Gazette Staff Writer
Osteoporosis has been dubbed "the silent disease" because the condition that makes bones brittle is seldom detected until a wrist splits or a hip fractures.
It could be called the "silent disease" for another reason: Simple steps anyone can take to slow down the disease are falling on deaf ears.
"Osteoporosis is a classic example of a disorder that is perceived to happen only to other people," said Dr. John P. Bilezikian, director of the Metabolic Bone Diseases Program at Columbia University in New York City.
Although researchers have a pretty good handle on how to slow down or prevent the bone thinning condition, few of the millions of women reaching menopause - and particularly those in their younger years - are heeding the recommendations, specialists say.
To address this concern, some local hospitals are launching programs to help primary care doctors teach patients why it's important to prevent osteoporosis. A recent national survey showed that only a third of these front-line doctors are discussing the disease with their patients.
And state legislators backing a proposal to require insurance coverage of bone density tests are expected to make renewed appeals next week in Harrisburg to bring more attention to the issue.
For the first time last fall, the National Osteoporosis Foundation helped sponsor walks called "America Walks for Strong Women" in Greensburg and in Atlanta, Denver, Detroit, Miami and Memphis to promote healthy living and raise awareness about the dangers of osteoporosis.
Osteoporosis occurs when not enough new bone is formed or when too much bone is removed.
The internal structure of a normal bone is spongy and porous. With osteoporosis, the actual bone tissue wastes away, causing holes or pores to enlarge. This decreases the density of the bone, causing it to weaken and fracture. One in two women and one in eight men are at risk of a fracture because of osteoporosis.
The seeds of osteoporosis can be sown during youth if not enough bone is formed during the growth years.
Throughout adulthood, after bone density has reached its peak, accelerated bone loss can occur because of physical or lifestyle factors that affect bone health, such as smoking and/or inactivity.
For women, the decrease in estrogen production at menopause results in bone loss, which can be rapid and severe, according to the [National Osteoporosis Foundation, based in Washington, D.C.]
Any bone can be affected, but fractures of the hip or spine are the most debilitating for older people. A hip fracture usuallys requires hospitalization and surgery.
It can impair a person's ability to walk unassisted, causing patients to lose their independence, or possibly require a move to a nursing home.
Forty percent of those who break a hip will be sent to a nursing home, according to the American Academy of Orthopedic Surgeons. Twenty percent will die within a year.
The proper fix
Health experts say America's quick-fix mentality is thwarting attempts by specialists to educate patients on the need to follow long-term, healthful habits that can prevent serious bone loss.
With an increasing number of hormone replacement drugs on the market that help preserve bone density, Americans may think popping pills will cure the disease.
But the disease can be significantly slowed with early, preventive steps. Among them are following a balanced diet rich in calcium and Vitamin D and engaging in weight-bearing exercises.
"I've seen it written that osteoporosis is the pediatric disease with adult consequences," said Jane Cauley, epidemiologist and the University of Pittsburgh's Graduate School of Public Health.
"Prevention has to extend to our younger girls while their bones are filling in," she said.
The information is out there, but about 28 million Americans may be at risk for osteoporosis.
Of that number, 10 million are afflicted now and another 18 million have a low enough bone mass to put them at an increased risk.
Men can get osteoporosis [an estimated 2 million men have the disease], but women are the most susceptible to thinning bones - partly because females start their lives with less bone density than males.
Getting the message across has been a difficult task.
"It's hard to get through a week without finding that patients are taking expensive drugs, but they have never heard of calcium," said Dr. Sherwood Chetlin, chief of rheumatology at Allegheny General Hospital. "Forget the cheap stuff [calcium]. Nobody wants to hear about that. They want us to fix the osteoporosis. We can't."
Health columnist and author Jane Brody blames our impatience on a lack of understanding of the importance of good health practices.
"We're a generation that has lost sight of the critical role that lifestyle plays in health," Brody said. "I think it takes years of drumming it in."
Making prevention easier
Next Tuesday, state Sen. Jay Costa, D-Forest Hills, will hold a news conference in Harrisburg to promote legislation requiring health insurance coverage for diagnosis and treatment of osteoporosis.
"We're promoting prevention as being much cheaper than treatment," said Ken Varhola, a Costa spokesman.
The disease affects more than 1.4 million Pennsylvanians over age 50. The resulting fractures cost of more than $10 billion every year.
Many health insurance policies may cover treatment for those with apparent symptoms of the disease, but not screening tests, which can cost $150 to $300.
The tests often are performed at hospitals in a procedure called Dual-Energy-X-ray-Absorptiometry, which measures bone mineral content and density of specific bone sites susceptible to fracture. Usually the spine or hip bones would be measured.
Newer machines measure a "peripheral" site, usually a heel, to obtain an estimate of bone density in the body. These machines are becoming popular because they are simple and inexpensive to use, offer quick results and are easily transportable. However, women who receive a low-bone measurement on these machines should be referred to a spine or hip measurement for more accurate analysis, according to osteoporosis specialists at Magee-Womens Hospital.
The Food and Drug Administration recently approved an ultrasound device (the Sahara Clinical Bone Sonographer) that scans a woman's heel in 10 seconds to determine density. This is much faster and costs about $40.
Later this summer, the FDA is expected to approve the Achilles+ Densitometer, also a ultrasound. It may provide a more precise result than the Sahara.
Experts recommend women should have bone density tests when they enter menopause so doctors know whether to initiate any therapy.
In Washington, Pa., Washington Hospital's Women's Health Care Services is asking primary care physicians to measure patient height during yearly physical examinations.
If a patient shrinks 1 to 11/2 inches a year, it's likely that osteoporosis is present, said Lisa McVay of the Women's Health Care Services. The reduction is caused by vertebral fractures, which is not a normal part of aging.
A national survey by Mission Pharmacal, the makers of Citracal, a calcium supplement, found that only a third of physicians discuss osteoporosis and prevention with their women patients.
Moreover, the women patients don't bring up the subject, the survey found.
The hospital wants doctors and patients to start talking with each other about preventive measures.
Medical experts know they may sound like alarmists, but they also are hopeful.
"There's a great deal left to do," said Chelin of Allegheny General, "But it's clear that we are learning we need to put our time and energy on prevention."
Related stories:
Osteoporosis: Causes and prevention
Osteoporosis: For more information
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