Mary Pat Roy is tired of hearing people accept what they think is inevitable.
“Everyone thinks osteoporosis happens as you age, which it does, but it doesn’t mean you have to fracture,” said Roy, director of the Center for Healthy Bones in Northampton. “I hear so often, ‘my mother broke her hip, but she’s 82 years old.’ We think of a fracture as something that just happens when we age, but it doesn’t have to.”
It’s important, she said, to distinguish between osteoporosis, which in itself is not a harmful condition, with the fractures it causes in later years — which can be life-threatening, particularly hip fractures.
Osteoporosis, simply stated, is a disease that causes bones to lose mass and become fragile. Some 10 million Americans — 80% of them women — currently have the disease, but another 35 million people over age 50 are estimated to have low bone mass, placing them at risk for the disease later in life.
Regular screenings during the senior years are important, doctors say, because if not prevented or if left untreated, osteoporosis can progress painlessly until a bone fractures, usually in the hip, spine, or wrist.
Hip fractures almost always require hospitalization and major surgery and, depending on the patient, can hinder the ability to walk unassisted and may cause permanent disability or even death. Spinal or vertebral fractures also have serious consequences, including loss of height, severe back pain, and deformity.
The good news, said Roy when she sat down to speak with BusinessWest, is that, while osteoporosis may be a too-common threat, people can take steps in their diet and lifestyle while they’re younger to live fracture-free down the road — steps as simple as getting a little more fresh air.
The bad news is that fewer Americans than ever are taking those necessary steps — and that could make it more difficult, later in life, to take any steps at all.
Bad to the Bone
Roy isn’t one to mince words.
“Our kids’ bones are lousy right now,” she said, and it’s causing some alarm in the bone-health community.
“I grew up in a generation where kids drank milk at every meal; now it’s diet soda or even regular soda with every meal,” she said, a habit that can lead to calcium deficiencies. “And they’re not outside playing and getting enough Vitamin D from the sun.” As a result, doctors are starting to recommend much higher daily allowances of D in young people’s diets, 1,000 units a day as opposed to the old standard of 400, to make up for the loss of sun exposure. Supplements can help restore the vitamins, but the old-fashioned way is ideal, she said.
“We’ve got to get kids drinking milk, eating yogurt, forgoing sodas, and getting outside to play. Instead of sitting in front of video games, go play kickball or something.”
It’s not a lifestyle change that people can afford to put off for too long, Roy explained, because by age 30, most people’s bones are as thick as they’re ever going to be. Worse yet, women have built about 98% of their potential bone mass by age 20. After that, bone mass begins a long, slow decline, but people can drastically reduce their chances of fracturing in their later years if they’ve built up as much bone mass as they can early on.
“Most of the bone stuff is common sense,” she said. “Eat a healthy, balanced diet. Take a walk every day. Carrying 150 pounds around for a 30-minute walk is going to build bone, not sitting on your 150-pound butt.”
And young men shouldn’t ignore these guidelines either, Roy said. They comprise only about 20% of osteoporosis cases, but that’s more a matter of demographics than decreased risk factor. Specifically, men run about 10 years behind women when it comes to bone loss and incidence of fractures, with doctors recommending men get screened starting at age 75, and women at age 65. Add to the fact that women live longer lives than men, and it helps explain some of the disparity in numbers. But once osteoporosis does set in for men, the fracture risk is just as serious as it is for women.
Osteoporotic fractures are serious business. According to the National Osteoporosis Foundation, about 24% of hip-fracture patients age 50 and over die in the year following their fracture. Meanwhile, 20% of those who were ambulatory before their hip fracture require long-term care afterward, and at six months after a hip fracture, only 15% of patients are able to walk across a room unaided.
The foundation estimates the annual direct-care costs related to osteoporotic fractures to be about $18 billion, and it’s rising as people live longer and Baby Boomers enter the prime years for bone disease. That’s partly why the World Health Organization (WHO) plans to release new screening guidelines for osteoporosis later this year.
In the meantime, Roy said, doctors can do their part by always measuring the height of patients who stop in for checkups, as height loss is an indicator of bone disease — an especially helpful gauge considering that osteoporosis tends to be symptom- and pain-free until a fracture occurs.
“It needs to be done every visit,” she stressed. “It’s low-tech, no-cost, and it tells you if something is happening with the bones.”
Roy said the medications used to treat osteoporosis are getting better all the time, but they won’t be maximally effective unless people have taken the steps early in life to build their bone mass and decrease their fracture odds.
“The new WHO guidelines are going to help you figure out your chances of having a fracture, and that’s the bottom line; that’s the only reason we care about osteoporosis,” she said. “We wouldn’t care about blood pressure if not for strokes, and we only care about osteoporosis because it might lead to a fracture. And bone density is a more accurate predictor of a fracture than blood pressure is of a stroke, or cholesterol levels are of a heart attack.”
In other words, pay attention to whatever the new screening guidelines might be.
Oh, and some fresh air wouldn’t hurt.
Joseph Bednar can be reached at[email protected]