20 October 2004

---Make No Bones About It!

October is Osteoporosis Awareness Month here in the Philippines, and if my memory serves me right, there was a Presidential Proclamation (during Erap Estrada's term) declaring every second week of October of every year as a National Osteoporosis Awareness Week.

How well do you know about osteoporosis and how much do you really care for your bones?

Osteoporosis is a disease state in which bones of the body become thinner or more porous, making them brittle, and making people afflicted with it to be highly susceptible to fractures. It is not a disease that solely affects women. It is just associated with them more often because of its higher incidence among postmenopausal women. Estrogen levels have a bone-protective mechanism among females and as they age and experience menopause, estrogen levels dwindle, and so does the bone protection they used to have. In a vulnerable state, even a minor fall can cause devastating fractures that promises disability --- and worse, death --- if not managed properly.

One of my favorite science book authors and medical writer, Gina Kolata, wrote yesterday an article in the Times in which she deplored not only the lack of information among most Americans on osteoporosis, but also the lack of proper approach and management from doctors who see such cases. She wrote:

For example, she said, doctors should routinely evaluate people over 50 who break a bone, for any reason, to see if they have osteoporosis. But such evaluations are seldom ordered.

Doctors should also make sure that older people get enough vitamin D, because deficiencies greatly increase fracture risk, Dr. McGowan said. But this, too, is rarely done. [New York Times]

Gina Kolata also highlighted the contents of a report from the surgeon general on bone health that was released last week that had "an ambitious goal: to educate doctors and the public so that they can put into practice what researchers know about preventing and detecting the bone disease."

The report urges that doctors and patients pay attention to bones throughout life. Children and adolescents need a proper diet and exercise to stimulate bone growth. For adults, eating properly and staying active can maintain bone strength.

The report recommends that people over 50 who are at high risk for osteoporosis --- women with a strong family history of the disease, for example --- and anyone over 65 have a bone density test. Older people should also take simple measures to prevent falls, like removing small rugs from their homes.

But paying close attention to fractures is near the top of most experts' list of largely ignored medical interventions. [New York Times]

Ms. Kolata also lamented the fact that most doctors --- primary care physicians, orthopedic surgeons, radiologists, and even rehabilitation specialists --- are not on their toes in pinpointing possible candidates for bone density tests. For the uninformed, bone density tests measure how much bone you got in your bones.

Radiologists and primary care physicians should also be alert for presence of vertebral fractures which should be good hints that a person has osteoporosis.

Another neglected item is Vitamin D supplementation, which is necessary for proper calcium absorption.

Summing up, I think the following issues need to be addressed to prevent osteoporosis:
  • have some form of daily exercise

  • eat food items rich in calcium or take calcium supplements

  • make sure you get enough Vitamin D, you can get this by exposing yourself to sunlight (before 10am and after 3pm)

  • doctors should suspect osteoporosis in fracture cases especially in the elderly

  • radiologists and rehabilitation specialists should help in recommending patients for possible bone density tests
Make no bones about it, you should begin caring for your bones today.

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