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Old 10-19-2004, 10:52 AM   #1 (permalink)
 
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Good NY Times Vitamin D Article

October 19, 2004
The (Often Neglected) Basics for Keeping Bones Healthy
By GINA KOLATA

n surveys and focus groups, most Americans say they know what to do to protect themselves against osteoporosis, the disease of fragile bones that often occurs in the elderly: eat lots of calcium-rich foods or take a calcium supplement.

Many say they are doing just that, or plan to.

But this response worries osteoporosis researchers like Dr. Joan McGowan, chief of the musculoskeletal diseases branch at the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Consuming calcium, she and others note, can at best make a small difference in osteoporosis risk, while other methods that can have a more substantial effect are often ignored.

Dr. McGowan is one of two scientific editors of the surgeon general's report on bone health that was released last week. The report has 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 lack of this knowledge, Dr. McGowan said, often leads to bad practice.

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.

Osteoporosis, the most common bone disease, is grimly serious, afflicting 10 million Americans over age 50 annually.

Each year, the report found, about 1.5 million Americans break bones because of osteoporosis, costing the health care system $18 billion. Often, the bone that is broken is the hip. And a hip fracture can set off a spiral leading to a nursing home and death: 20 percent of people who break a hip die within a year, the report said.

Osteoporosis can be prevented and treated with drugs that keep bones from breaking down - if people realize that they have it.

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.

"When you see people over 50 who fall and break a wrist bone, you need to stop and take a look," said Dr. Richard H. Carmona, the surgeon general. "We need to take one step back and say, 'Why should that bone have broken from a simple fall?' "

That advice is not just for broken wrist bones, Dr. McGowan added.

"One of the ideas that people have is that you earned your fracture," she said. "You tripped, or you were ice skating with your granddaughter and you fell and broke your arm. Well, how many times did your granddaughter fall and not break an arm?"

Dr. McGowan said that a fracture was "really a sentinel event in an older person - any fracture."

"I don't care if you got it falling off a bike or even in a traffic accident," she continued.

Yet too often, she said, doctors do not send patients with broken bones to be evaluated to see why the bone broke in the first place.

The American Academy of Orthopaedic Surgeons agrees.

In a position statement last year, it urged members to do more than just repair fractures in older people.

"There is a terrific information gap," said Dr. Laura Tosi, an orthopedic surgeon at George Washington University and a member of the academy's board. "Orthopods know how to put metal in and get people up and going, but if you don't prevent future fractures, people will end up disabled."

It is not just orthopedists who often miss opportunities. In a paper published last year in The Journal of Clinical Endocrinology & Metabolism, Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center at New York-Presbyterian Hospital/Columbia University Medical Center in New York, and her colleagues reviewed the data and found it depressing.

"In virtually all the reports that have been published in the past few years, physicians who deal directly with the fracture event rarely take appropriate action," they wrote. "This includes radiologists who review X-rays that include the spine, orthopedic surgeons who treat acute fractures, physiatrists who oversee rehabilitation after the fracture, and primary care physicians to whom the patients return for overall care once the fracture has healed."

For example, in one study reviewed in the paper, of 934 women over age 60 who had routine chest X-rays, 132 had visible moderate to severe vertebral fractures. But only 17 of them had these fractures noted on their discharge statements.

Another underappreciated problem, osteoporosis experts say, is a lack of vitamin D, which bones need to absorb calcium and phosphorus. Vitamin D deficiencies greatly increase the risk of fractures. Yet a new national study by Dr. Michael Holick of Boston University, of about 1,500 postmenopausal women with osteoporosis, found that half had vitamin D levels below what is considered ideal.

Vitamin D is made in the skin in response to sun exposure, but many people do not get enough sunlight, Dr. Siris said, noting that there is a concern about skin cancer. "People today are sun-averse," she said. "And in the elderly, who don't go outdoors, this is a real issue."

She added that the deficiency was easily corrected by vitamin D supplements that cost as little as $3.40 for 100 pills.

Osteoporosis is a real problem, Dr. Siris said. "This is not something made up by the pharmaceutical industry."

But for people who are worried about ending their days bent over with the disease, or with a broken hip in a nursing home, Dr. Carmona has a message.

"You don't have to be a hunched over old lady or old man," he said. "If you pay attention to bone health."

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Old 10-19-2004, 07:26 PM   #2 (permalink)
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Don,you always find the good stuff!
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Old 10-19-2004, 08:28 PM   #3 (permalink)
 
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It was good, too bad they didn't recommend indoor UV exposure, and too bad they mentioned this: "She added that the deficiency was easily corrected by vitamin D supplements that cost as little as $3.40 for 100 pills"
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Old 10-20-2004, 12:18 AM   #4 (permalink)
 
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Neon:

Agreed, but the important thing to note is that members of the medical community are (a) publicly disagreeing with the wisdom of sun avoidance and (b) talking about the importance of maintaining optimal levels of vitamin D.

Compare this to five years ago when this article wouldn't have been written.

One small step at a time!

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Old 10-20-2004, 07:02 AM   #5 (permalink)
 
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Old 01-15-2007, 11:52 PM   #6 (permalink)
 
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Re: Good NY Times Vitamin D Article

<bump> i miss don's input on tantalk :)
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Old 01-16-2007, 08:05 AM   #7 (permalink)
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Re: Good NY Times Vitamin D Article

Don is very active at Tanformation - lots of good stuff!
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Old 01-16-2007, 08:20 AM   #8 (permalink)
 
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Re: Good NY Times Vitamin D Article

Very good Don.Always good info
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