Health

Baby boomers: Act now, save bones

The surgeon general warns of an impending epidemic of brittle bones unless Americans, male and female, focus on prevention.

	[Times photo: Autumn Cruz]
	Catherine McCloskey of St. Petersburg, who has osteoporosis, moved to a nursing home almost five years ago. "This is the fourth time I've been here," she said. "It took a me four times to learn I couldn't live by myself."

Aging baby boomers face an epidemic of costly, disabling bone disease in the next 15 years unless they take steps to prevent it, the U.S. surgeon general said Thursday in a first-ever report on bone health.

By 2020, half of Americans over 50 will either have osteoporosis or be at risk for it, said Surgeon General Richard Carmona. The number of hip fractures could double or triple in that time.

"We need to change the way we look at our bones," said Dr. Allan Noonan, senior adviser in the Surgeon General's Office and one of three scientific editors of the report. "Change the way we look at aging and our bones. Realize that osteoporosis is not just a natural consequence of aging, and realize there are things that we can do."

More than 10-million Americans already have osteoporosis, a disease in which bones lose vital minerals, such as calcium, so they weaken and break easily. Nearly 34-million are at risk because they have low bone mass.

Unless things change, the report says, by 2020 nearly 14-million Americans will have osteoporosis and almost 48-million will be at risk. And, while women are most at risk, men get the disease, too. The forecast includes more than 3-million men with the disease.

Part of the problem, Noonan said, is that bone health doesn't get the same attention as better-known threats, such as cancer and heart disease.

"In a way, we take our bones for granted," he said. "They're not very visible. We take them for granted unless we fracture them."

The report stresses hope. Most people can prevent bone disease with physical activity, good nutrition, taking calcium and vitamin D - and by thinking about their bones before they get old. For those already at risk, new drugs can help stop breaks.

It contains a broad array of tips that include getting enough calcium and exercise, taking yoga to improve balance and prevent falls, and placing grab bars in the shower.

But right now, the report says, there is a broad gap between what scientists know about preventing osteoporosis and what Americans practice. Carmona chided doctors as well, saying too many doctors fail to diagnose and treat osteoporosis, even for older patients who have broken bones.

"We need to get primary doctors thinking more about bones," Noonan said. "When you're treating someone for a fracture, you need to think beyond the cast."

Catherine McCloskey of St. Petersburg hopes that Carmona's report will grab people's attention. She has struggled with osteoporosis since 1982, when she was 56. She was closing the garage when the cord pulled out of the door. She fell to the concrete driveway and broke her hip.

Over the years, she has broken both shoulders and her pelvis, twice. Her leg. A knee. Her back hurts when she walks, but she hasn't done that since Christmas. Her spine curves so much, she has lost several inches from her younger height, 5 feet 4 inches.

"I try to stand straight," she said.

McCloskey, now 78, takes pills to keep her bones from getting weaker. She hasn't broken a bone in a long time, not since she moved to Bon Secours Maria Manor nursing home almost five years ago.

"This is the fourth time I've been here," she said. "It took me four times to learn I couldn't live by myself."

Once people develop osteoporosis, it often leads to a cascade of other health problems. Twenty percent of people who have a hip fracture die within a year. A woman with a curving spine may get lung infections and digestive troubles once she can't stand up straight. As people become less active, there's a greater risk of bedsores and skin problems.

"It's a domino effect," said Karen Oliver, Bon Secours' director of nursing.

Then there is the problem of chronic pain in people with compressed spines. Sometimes it's hard to decide the best way to help, Oliver said.

"It's kind of a Catch-22," she said. "You want them free of pain, but then you have side effects."

In Tampa, Dr. Joanne Valeriano-Marcet sees patients with osteoporosis every day. An associate professor at the University of South Florida's medical school, she specializes in bone diseases.

"The exciting thing about this report is that the surgeon general is taking an interest," she said. "This is something that's really important." Bone diseases cause about 1.5-million fractures that cost $12.2-billion to $17.9-billion a year.

Doctors refer some of the most complicated cases to Valeriano-Marcet, including patients with more unusual bone diseases and those who keep breaking bones, even after they start taking the new drugs to prevent bone loss.

But Valeriano-Marcet hopes the report will hit home with those who aren't her patients - yet.

Prevention is what's important, she said. "You've got all your kids not drinking milk."

Back when she was a girl, McCloskey always did. But only because her mother made her. She stopped once she got older, she said.

"That probably had something to do with it . . . but I didn't realize it," she said. "Here at the nursing home, I drink it every day."

Lisa Greene covers medicine for the St. Petersburg Times. She can be reached at greene@sptimes.com

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