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Dr. Richard C. Smith is affiliated with the Florida Center for Orthopaedics.

Bone health is important to the overall health and quality of life for all Americans. Testament to this is the fact that this past May was deemed National Osteoporosis Awareness and Prevention Month.

Healthy bones provide the body with a frame that allows for mobility and for protection against injury. Bones serve as a storehouse for minerals that are vital to the functioning of many other life-sustaining systems in the body. Unhealthy bones, however, perform poorly in executing these functions and can lead to debilitating fractures.

The bone health status of Americans appears to be in jeopardy, and left unchecked it is only going to get worse as the population ages. Each year, an estimated 1.5 million individuals suffer an osteoporosis-related fracture. In the U.S., 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone mass, placing them at increased risk for osteoporosis.

Great improvements in the bone health status of Americans can be made "simply" by applying in a timely manner that which is already known about prevention, assessment, detection, diagnosis, and treatment.

Unfortunately, one of the biggest issues is the large gap in osteoporosis prevention between what has been learned and what is
applied by American consumers and health care providers. The biggest problem is a lack of awareness of bone disease among the public and health care professionals.

What is osteoporosis?
Osteoporosis affects millions of Americans. These individuals with osteoporosis are at high risk of suffering one or more fractures, which are often physically debilitating and can potentially lead to a downward spiral in physical and mental health.
By definition, osteoporosis is a disease characterized by low bone mass and structural deterioration of bone tissue. This leads to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist.

How can healthcare providers make a difference?
Individuals have a critical role to play in promoting their own bone health. However it is perhaps more important that all health care professionals, especially primary care providers, have the opportunity and responsibility to assist them in this task by promoting awareness of factors that influence bone health; identifying patients at risk of bone disease; and providing lifestyle and therapeutic interventions to prevent bone loss and fractures.

Nurse practitioners, nurse midwives, and physician assistants can contribute significantly to the provision of bone health care. They can educate patients on nutrition and physical activity recommendations, ensure proper screening, and monitor compliance with treatment. Physical therapists, occupational therapists, pharmacists, and dietitians can play valuable roles in helping patients achieve maximal physical function and bone accrual.

Those in greatest need should receive a full assessment of bone health.

Today, new diagnostic methods, such as DexaScan technology from GE Healthcare, are available that can help identify those in the population who are at highest risk of fracture.

How does new imaging technology work?
The most common imaging technology in use today is bone mineral density (BMD) testing, which should be performed on any patient for whom risk factor analysis indicates a strong potential for osteoporosis. Formal guidelines have been developed recommending BMD testing in certain populations, including postmenopausal women over age 65, younger women with multiple risk factors, and men and women with fragility fractures or who have other diseases or take medications that can greatly increase the risk of fracture.
BMD testing can help healthcare providers confirm diagnosis of osteoporosis. It is one of the most accurate ways to assess bone health, aids in monitoring bone loss over time, can detect osteoporosis at the earliest stages, and enables health care providers to determine how well or poorly treatments are working.

BMD testing is most commonly performed with low dose x-rays, on a cushioned table. While lying flat the patient has a scanner pass over the body. The machine is able to get clear readings of bone quality across the patient's entire body, particularly spine and hip.

All women aged 65 and older should undergo bone density testing as recommended by the U.S. Preventive Services Task Force and the National Osteoporosis Foundation. Bone density testing should be considered in men with fragility fractures; those on therapies that may cause bone loss, notably glucocorticoids or androgen deprivation; and men with multiple risk factors.

While it sounds simple, everyone should be informed of the basic elements of maintaining bone health and preventing bone disease. Paying attention to the basics — appropriate physical activity, nutrition, and smoking cessation — is critical for everyone, especially those who have, or who are at risk of developing, osteoporosis.



June 2007

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