Bones, beautiful bones
'I don't get no respect," the late comic Rodney Dangerfield would have said had he been a bone. Bones bore us. We perk up at heart talk, grab on to the latest findings about minds and brains, revere muscles, and can't seem to get enough studies about skin. For most people, however, and that includes medical professionals, it's just assumed that if bones aren't broken, they don't need fixing. Which is why Surgeon General Richard Carmona released "Bone Health and Osteoporosis" two weeks ago. We should all stand tall and salute this 404-page report--while we still can. It's at www.surgeongeneral.gov .
This first-ever osteoporosis report by a U.S. surgeon general observes that our skeletons begin to crumble long before they break. Some 34 million Americans live for years while calcium slowly drains from their bones, a state called osteopenia. It's short of osteoporosis but still puts bones at risk of fracture. An additional 10 million Americans over 50 progress to full-blown osteoporosis, in which bones not only dangerously demineralize but also deform as the elegant internal architecture of the spongy bone matrix collapses. The skeleton becomes delicate and fragile, unable to bear weight. Spines shrink and backs curve into a C. Hips shatter. Wrists snap.
Women fare worse than men because they abruptly lose bone-protecting estrogen at menopause. Nursing homes are full of hunched, shrunken grandmas, hobbling behind walkers after being admitted solely because of a broken hip. But the Carmona report shows us that osteoporosis is a guy thing, too. It comes on more slowly and later in life--but 1 in 4 men will face an osteoporotic fracture as they age. Bones hit their peak mass when people are in their 20s, and after about 35, a little more bone is lost every year than the body can rebuild.
Over the past decade or so, we have seen major advances in treating unhealthy bones. Special X-ray machines can measure bone density well before it falls into the osteoporosis danger zone (a "T-score" below -2.5). If bone density is too low, we can jump in with bone-strengthening treatments that lower fracture risk--bisphosphonate drugs (Fosamax and Actonel) and hormones (low-dose estrogen, estrogen mimics such as Evista, and parathormone), added to dietary supplements and weight-bearing exercise.
But boomers will never be able to reclaim the robust skeletons of their youth. And that may be among the most critical of the many public-health messages in the surgeon general's report. The higher the peak bone mass when you're young, the better your bones will age. Young people need to know that once out of their 20s, there is no turning back. The good news is that they have the power to create denser, tougher bones before then, and the formula is simple: lots of calcium, adequate vitamin D, and working out.
Clueless to the bone. Whether or not they listen, most young people at least know that exercise is important. But when it comes to calcium and vitamin D, most don't have a clue, and the reality is that our hypernourished nation is vastly undernourished in this regard. People have been abandoning dairy products, the major source of dietary calcium, for years, and when given the chance, the young choose soda over the white stuff. For young women, the average daily intake of calcium is around 600 milligrams a day, but they need twice that much. Higher calcium intake increases bone density, and to hold on to that hard-earned bone mass, you have to keep up the calcium for a lifetime.
Without sufficient vitamin D, however, the full effect of a calcium-rich diet or calcium supplements won't be realized. Vitamin D is actually a hormone that increases muscle strength and helps calcium get where it needs to go. Bone experts believe the current federal recommendation of between 200 and 600 international units of vitamin D a day, depending on age, should be hiked to 800 to 1,000 IU for everyone--something that may happen later this year.
The surgeon general has issued the prescription, but it is up to us, his patients, to fill it. To make these lifestyle changes, young people need to become enamored of their bones. They must see bones as vital and beautiful. Building up sturdy, long-lasting bones in our young people is the way we will create a future that isn't full of hobbling grandmas and stooped grandpas. That will bring us all some respect.
This story appears in the November 1, 2004 print edition of U.S. News & World Report.