Health and Osteoporosis: A report of the Surgeon General
October 15, 2004 -- On Thursday, 10/14/04, U.S. Surgeon General Richard
H. Carmona, M.D., M.P.H., F.A.C.S. presented his report on bone health
and osteoporosis. This landmark report highlights the lack of awareness
about optimal bone health and is a call to action for all Americans
to improve and maintain healthy bones.
The importance of bone health and the consequences of poor bone health
were readily apparent in this report. Statistics from the report revealed
• 10 million Americans over age 50 have osteoporosis, the most
common bone disease.
• 34 million Americans
are at risk with low bone mass or 'osteopenia'
• 300,000 hospitalizations
occur each year due to hip fractures
• 1.5 million people
each year suffer a fracture from osteoporosis
• 1 out of every 2 women
over age 50 will have an osteoporosis related fracture in their lifetime,
with risks increasing with age.
• The direct financial
expenditures range from 12.2 to 17.9 billion dollars per year (based
on 2002 dollars)
• Osteoporosis can occur
in men; 6% of white men over age 50 will suffer a hip fracture
However, these statistics should not frighten, but serve to emphasize
aspects of proper development and maintaining health bones. In fact,
the report emphasized that the bone health status of Americans can be
improved by a straight forward prevention strategy. This prevention
strategy includes healthy nutrition, physical activity and regular medical
check-ups and screening for bone disease.
Healthy bones provide a strong foundation, allowing mobility and protection
from injury. They also serve as a bank for important minerals, such
as calcium, that help support numerous organs in our body. Developing
healthy bones begins at birth and proceeds throughout life. The human
body builds calcium in bone until about 30 years of age. After the mid-30's,
bone loss slowly begins to occur. Women lose bone quickly after menopause.
Importantly, healthy habits can limit the bone loss that occurs.
While genetic factors play a role in determining bone mass and strength,
one can impart a strong skeleton by positively impacting controllable
factors. Some things that can be controlled include:
enough calcium and vitamin D
hazards in your house to reduce risk of falling and breaking bones
your medications with your doctor and/or pharmacist that would weaken
a healthy weight
• Not smoking
"The good news is that you are never too old or too young to improve
your bone health," Dr.Carmona said. "With healthy nutrition, physical
activity every day and regular medical check-ups and screening, Americans
of all ages can have strong bones and live longer, healthier lives."
The report states that the composition of the diet plays an important
role in building and maintaining bone mass throughout life. Lack of
calcium intake has been singled out as a major public health concern
because it is critically important to bone health and the average American
consumes levels of calcium that are far below the amount recommended
for optimal bone health. Calcium rich foods include milk, cheese, yogurt,
leafy green vegetables and soybeans. One cup of vitamin D fortified
milk provides about 300 milligrams of calcium and 50 IU of vitamin D.
Therefore, approximately three 8-ounce glasses of low-fat milk each
day, combined with the calcium from the rest of a normal diet, is enough
to meet the recommended daily requirements for most individuals.
Calcium supplements can be helpful for individuals who do not get enough
calcium in their diet. Pertinent information about calcium supplements
from the report include:
• All major forms of calcium (e.g. carbonate, citrate) are absorbed
well when taken with meals.
from supplements or fortified foods is best taken in several small doses.
It is best to limit intake to 500 - 600 milligrams at any one time.
supplements may differ in their absorption due to manufacturing processes.
• In a
recent evaluation of calcium sources, calcium carbonate supplements
were found to be the least expensive supplemental source of calcium.
Vitamin D is important for bone health because it aids in the absorption
of calcium. Numerous Americans are deficient in vitamin D, especially
nursing home residents, hospitalized patients and adults with hip fractures.
The main source of vitamin D is from the skin by exposure to sunlight.
Several factors limit production vitamin D by the skin, including lack
of sun exposure in northern climates, degree of skin pigmentation, and
The following table lists the recommendations for calcium and vitamin
D intake by age. Please note that the highest amount of calcium recommended
is for children and adolescents, a period of time when bone growth is
very rapid. Also, pregnancy and breastfeeding is a time of rapid bone
turnover. Requirements for calcium and vitamin D intake are age dependent
and listed below.
Calcium and Vitamin D Requirements:
||Calcium (milligrams per day)
||Vitamin D (IU per day)
|over 70 years
|Pregnancy and Breastfeeding
|Less than 18 years
Physical activity and maintaining a healthy body weight is important
throughout life for bone health. Physical activity that involves weight
bearing or impact exercises are most useful to maintain or increase
bone mass. Examples include: walking, tennis, gardening, biking, aerobics
or golf. Other, non-weight bearing activities help improve balance and
coordination and could reduce the risk of falling. Recommendations include
at least 30 minutes a day for adults and 60 minutes for children. The
report noted that all types of physical activity can contribute to bone
Regular medical check-up and screening
The health care provider and patient relationship is an important part
of bone health promotion. An inquiry of risk factors for poor bone health
and osteoporosis should be evaluated at all ages. Assessing history
of fracture, calcium and vitamin D intake, physical activity and controllable
factors (such as smoking) should be routinely discussed during a medical
Screening for bone thinning and osteoporosis should be done for all
at risk patients. A bone mineral density test is a quick, painless,
and safe test that will evaluate the health of your bones. All women
over 65 years of age should have a bone mineral density test.
Osteoporosis is a disease of bone thinning and deterioration that leads
to fragile bones and increases the risk of fracture. Fragile bones are
not initially painful. Most people do not realize they have bone thinning
until a fracture occurs. Once a diagnosis of osteoporosis or significant
bone thinning is made, treatment may be initiated with medications that
can help to prevent further bone loss and rebuild bone before life-threatening
fractures occur. Medications that prevent bone breakdown have been effective
in reducing risk of future fractures. Adequate calcium and vitamin D
are integral components for treating osteoporosis.
This report summarizes bone health and osteoporosis prevention and treatment
strategies. It is recommended to become familiar with ways to achieve
peak bone mass by optimizing calcium and vitamin D intake and exercise
throughout life. Take control of your bone health by discussing
your specific needs with your health care provider.
Click here to visit the Surgeon General Home Page
John A. Sunyecz, M.D., F.A.C.O.G.
content, MenopauseRx, Inc. The information provided by MenopauseRx,
Inc. is not intended to replace the medical advice of your doctor or
health-care provider. Please consult your health-care provider for advice
about a specific medical condition.