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Study: Half of women over 50 have weakened bones
By WES ALLISON A study of more than 200,000 postmenopausal women found almost half had weakened bones and didn't know it, suggesting that millions of American women, along with their doctors, are failing to protect themselves from osteoporosis and the bone fractures it can cause. It has long been known that roughly seven of 10 women will experience a significant loss of bone mineral density after menopause, which often leads to osteoporosis. But the study, published today in the Journal of the American Medical Association, exposed a wide gap between that understanding and what's being done about it. The authors and other experts said the findings show that primary care physicians must do a much better job of screening women for osteoporosis before they break something. And more patients must demand it. "The most disturbing thing about this study is that despite all the progress we've made in diagnosing and treating osteoporosis, there's still millions of women out there who are not being diagnosed and . . . therefore are not being treated," said Dr. Joel Silverfield, a rheumatologist at St. Joseph's Hospital in Tampa and author of Winning with Osteoporosis, a patient's guide. "And it's completely preventable." The National Osteoporosis Risk Assessment, or NORA, was the nation's largest osteoporosis study, taking place at more than 4,200 clinics in 34 states. It was funded and managed by Merck & Co., which makes a popular osteoporosis drug, Fosamax, and the International Society of Clinical Densitometry. Researchers recruited 200,160 postmenopausal women ages 50 and older with no previous diagnosis of osteoporosis or low bone mineral density. Each was asked to fill out a survey and given a quick, inexpensive test, called peripheral bone densitometry, which measures bone mineral density at the heel, forearm or finger. The scans showed that 40 percent of the women had the low bone density that's the precursor to osteoporosis, called osteopenia. Another 7.2 percent had full-blown osteoporosis. A year later, most of the women were examined again. Those with osteopenia were twice as likely to have broken a bone in the past year than those with normal bone mineral density. Those with osteoporosis, meanwhile, were more than four times as likely to have broken a bone. In a editorial accompanying the report, Dr. Charles H. Chesnut III of the University of Washington Medical Center wrote that the findings were similar to what researchers and specialists had feared. "Such underidentification of osteoporosis risk implies the undertreatment of osteoporosis," he wrote. Considering the availability of reliable testing and treatments, "such underidentification is unfortunate." Bones are constantly broken down and rebuilt by the body. As people age, especially women, the bones lose more than they gain, leading to reduced bone mineral density. Eventually that makes the bones spongy and prone to breaks, a condition called osteoporosis. Osteoporosis affects some 10-million women, including 2.1-million in Florida. The National Osteoporosis Foundation blames the disease for 1.5-million fractures a year, with a treatment cost of more than $13.8-billion in 1995 alone. Spine and hip fractures are a top cause of hospitalization for the elderly, and they frequently cost them their independence. Those who suffer a hip fracture also are 20 percent more likely to die within a year than others. "The problem is that it's not a disease in the early stages that has symptoms until you have fractures," said Dr. Bruce E. Robinson, a Sarasota geriatrician and professor of medicine at the University of South Florida. Recommendations for bone density screening vary. The National Osteoporosis Foundation suggests it for all postmenopausal women with added risk factors for the disease, such as family history and smoking. Women without risk factors can wait until they're 65, the group says. But other experts recommend testing much earlier. Silverfield urges his patients to get the test at the same time they get their first mammogram, around age 40. "If you get ahold of them then, when they're young, you can (help them) to quit smoking, exercise, take their calcium, get their Vitamin D," he said. The best defense against osteoporosis is an active life, starting in childhood, and a balanced diet rich in vitamin D and calcium, along with not smoking and moderate drinking. Among postmenopausal women, hormone replacement therapy also can slow bone loss. Once osteoporosis is diagnosed, several prescription drugs can help slow bone loss. Doctors are eagerly awaiting approval of another, called Forteo, that also appears to help the body rebuild lost bone mass. But neither the treatment nor the testing can do any good if doctors aren't checking, experts said. "Doctors tend still to be driven primarily by patient concerns. When patients come to them, the issue of what do to about low bone density just doesn't come up," Robinson said. "If (patients) ask, they'll likely get the attention they deserve."
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