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Health: The Bare Bones Of Personal Health Care

Purnima R. Sangal, M.D., FACOG

Make no bones about it. It’s time to bone up on your bones.
That’s the lesson to learn from the US Surgeon General’s first-ever report on bone health and osteoporosis issued in October 2004. Like many health reports, there’s bad news and good news.  

The bad news is that some 10 million Americans over the age of 50 have osteoporosis, and another 34 million are at risk of developing it. If nothing is done, the Surgeon General said, by 2020 half of all American adults over 50 will be at risk for fractures from osteoporosis and low bone mass.  

Even more alarming is the fact that osteoporosis is a “silent” condition because many people aren’t aware they have it, and often the first knowledge of the condition comes with a fracture. An additional barrier: bone health is a frequently overlooked aspect of health care.

Refuting a common myth that it primarily affects women, the report said that four times as many men and nearly three times as many women actually have osteoporosis than report having the condition. And with an aging population, bone disease and fractures likely will rise dramatically in the years ahead.
The impact of bone disease on patients and our health care system is enormous. One and-a-half million fractures occur in the US each year, causing more than half a million hospitalizations, some 800,000 emergency department visits, more than 2.6 million physician office visits, and nearly 180,000 nursing home placements. Hip fractures -- the worst kind -- account for some 300,000 hospitalizations every year. The estimated cost of caring for these broken bones is astronomical: direct care accounts for $12 to 18 billion annually, with indirect costs, such as lost productivity, adding untold additional amounts.

Bone health is vital, because bones serve two critical purposes. They provide a structural framework for the body that allows us to be mobile and that protects us against injury. Without bones, we couldn’t walk, and our other organs – lungs, heart, etc. -- would have no protection. Bones also serve as a storehouse for minerals crucial to the function of bodily systems.  
The Centers for Disease Control describes osteoporosis (“porous bone”) as a disease of the skeletal system marked by low bone mass and deterioration of bone tissue. It leads to greater risk of fractures, typically in the wrist, hip, and spine. Like other chronic diseases, it’s a condition that affects the elderly more than others, but the Surgeon General cautions that osteoporosis and fractures should no longer be thought of as an inevitable part of aging.

The good news is that we have the power to do something. By starting early in life, focusing on prevention, lifestyles changes, early diagnosis and treatment, we can avoid or at least slow down much of the damage from this bone disease.  

Here are recommendations from the Surgeon General that can improve bone health. Be sure to check with your primary care physician before taking any action that might affect your health.

•    Practice good nutrition, with a healthy diet rich in calcium and Vitamin D. Calcium is critical to bone health, and Vitamin D aids in the absorption and use of calcium. If you don’t think your diet gives you enough of either, consider supplements.
•    Get moving. Physical activity adds to and preserves bone mass and, because it increases agility, it can reduce the risk of falls, a leading cause of fractures.
•    Engage in strength and weight-bearing activities, which can build and maintain bone mass throughout life.
•    Maintain a healthy body weight. Being underweight raises the risk of fractures and bone loss.
•    Minimize the risk of falls, especially for those over 60. Install handrails and nonslip rugs or mats in appropriate locations throughout the home, wear shoes with nonslip soles, and remove “trip hazards” whenever and wherever possible.
•    Check with your heath care provider regarding medications. Some medications may affect skeletal health.
•    Stop smoking, which can reduce bone mass and raise the risk of fractures. Heavy alcohol use is also connected with reduced bone mass.
•    Talk with your doctor about your risk factors and whether a bone density test is appropriate for you.

For more information, visit the National Osteoporosis Foundation at http://www.nof.org or the Centers for Disease Control at http://www.cdc.gov/.

With bone health, as with many areas of health care, awareness and prevention are keys to success. But identification of osteoporosis and other bone diseases is also important, because treatment in early stages can be effective.

So before your next medical visit, when you’re writing down all those questions to ask your doctor, make sure you put your bones on the list. They’re that important.

(Purnima R. Sangal, M.D. is a Fellow of the American College of Obstetricians and Gynecologists, a practicing gynecologist at A Woman’s Place in Chelmsford, President of Indian Medical Association of New England, and Past President of the Middlesex North District Medical Society. Readers should use their personal judgment when seeking medical care and should consult with their personal physician for treatment. )

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