Osteoporosis Becomes a Growing Health Risk

JIM LEHRER:

And finally tonight, the growing health risk of osteoporosis. Our report is by Susan Dentzer of our health unit, a partnership with the Henry J. Kaiser Family Foundation.

SUSAN DENTZER:

Today Linda Johnson works out daily and looks like the picture of health. But 20 years ago, she kicked a soft foam Nerf ball across her kids' playroom and promptly broke a toe. Her children laughed.

LINDA JOHNSON:

They thought that was hilarious. They said, "I can't believe you broke your toe on a Nerf ball." I started making excuses, saying, "It couldn't have been; I must have done something else; maybe there was something in that Nerf ball or something."

SUSAN DENTZER:

Later, after Johnson broke four more toes and then an ankle, a doctor told her the Nerf ball was not the problem.

LINDA JOHNSON:

He said I had osteoporosis. I had two inches loss in height, and one from just these curves. This was curved over. The other was from the collapsed vertebrae in my back. And 40 percent bone loss… bone density loss all over.

SUSAN DENTZER:

Osteoporosis is a disease in which bones thin and become more porous and brittle. Sufferers like Johnson, who's now 57, may not know they have it until a bone breaks.

LINDA JOHNSON:

Osteoporosis is like having termites in your house. You really don't know you have them. It's a silent disease. You don't know you have it until you start breaking apart.

SUSAN DENTZER:

Reporter: In Johnson's case, the disease was brought on by an eating disorder that plagued her as a younger woman. It shut down her ovaries and her body's supply of estrogen. She's now restored some of her bone density with adequate calcium, medication and exercise.

Now the U.S. Surgeon General, Dr. Richard Carmona, says millions more women and men are at risk of osteoporosis. That's not because of eating disorders like Linda Johnson's, but mainly because longer-lived Americans are entering their golden years with poor bone health.

DR. RICHARD CARMONA:

Well, right now, there's about 10 million people who have osteoporosis. Those are people primarily over 50 years old.

There's another 34 million people who are at risk for osteoporosis. Approximately 1.5 million people suffer bone fractures every year related to osteoporosis at a cost of about $18 billion.

SUSAN DENTZER:

As a result, a new surgeon general's report released yesterday calls for a broad-based campaign of education and outreach to maintain and improve the nation's bone health.

DR. ETHEL SIRIS:

The surgeon general's report has a very major message, which is that osteoporosis is a common problem that affects a lot of older people, that it's preventable, and that it's treatable.

And that means we have to learn about it and we have to learn to deal with this disease, because we can do so much to help those at risk for it or those who have it.

SUSAN DENTZER:

Dr. Ethel Siris directs the Osteoporosis Center at New York-Presbyterian Hospital in Manhattan. She told us that good bone health actually begins in childhood as a result of a diet rich in calcium and other key nutrients, as well as adequate exercise.

DR. ETHEL SIRIS:

People think of bones as this kind of inert tissue that holds us up, and nothing could be farther from the truth. Yes, bone holds us up, but it's actually a living dynamic tissue.

As you grow, as a child and as an adolescent, and as you get into puberty, your bones actually grow in length. You deposit bone. Your bones get larger and longer in terms of the long bones, until you reach your maximum height.

SUSAN DENTZER:

Although bones usually stop lengthening in late adolescence, bone mass actually continues to build into the early 30s. And all the while bones are undergoing a continuous process called remodeling, in which the body constantly removes bits of old bone and replaces it with new material.

Dr. Siris says that in women, this remodeling process normally maintains bone mass at a steady state from the early 30s until menopause. Then, when ovaries cease to function, things take a sharp turn for the worse.

DR. ETHEL SIRIS:

As estrogen levels drop, there is marked increase in the bone removal process. And it's so aggressive that you may actually perforate through a section of bone and actually damage the structure. Bone formation tries really hard to keep up with what's being removed to replace it, but it can't quite do it.

SUSAN DENTZER:

That can lead first to osteopenia, decreased bone density, and if the process continues, to full-blown osteoporosis. That's what happened to one of Dr. Siris's patients, Barbara Levy. She's 79.

BARBARA LEVY:

Nine or ten years ago, I began to hear something about osteoporosis and I was… I was aware that I was shrinking and becoming a bit bent over. I didn't like it at all. I really rather resented it.

And I thought of all those old ladies whom I always see going around and those poor things who are bent over, you know, and obviously have lost height.

DR. ETHELE SIRIS:

Your height is a function of how long your legs are and how tall your spine is.

SUSAN DENTZER:

Reporter: Dr. Siris told levy her curved back was probably due to fractured vertebrae linked to osteoporosis. A bone density test like this one, a type of low-dose x-ray, confirmed the diagnosis.

The test result, known as a t- score, compares a person's bone mass with the average score for a young adult.

BARBARA LEVY:

It showed that my bone density in the critical areas– the wrist, the hip, et cetera, the back– were in poor shape.

SUSAN DENTZER:

Dr. Siris put Levy on Fosamax, one of several so- called bisphosphonate drugs that block the excessive bone removal following menopause.

Levy's bone density slowly improved. Then, five years ago, she fell and fractured her pelvis. Levy recovered. But Siris says many of the 1.5 million others who fracture bones each year are not so fortunate.

DR. ETHEL SIRIS:

Many of these individuals become depressed. They're very susceptible to other medical problems. It turns out that about half of the people with hip fractures wind up permanently in long-term care facilities.

Another 25 percent experience an earlier death than they otherwise would have. In fact, within a year after hip fracture, there's about a 20 to 25 percent increased risk of dying."

SUSAN DENTZER:

Levy is now on a medication called Forteo that's administered daily by injection. It's one of a growing class of so-called anabolic drugs that actually build bone, rather than simply stopping further bone loss. But Forteo is expensive, costing about $7,000 a year.

EXERCISE CLASS:

One, two, three, four…

SUSAN DENTZER:

With so many millions now at risk of developing osteoporosis and undergoing devastating and costly fractures, the surgeon general's report calls for an unprecedented emphasis on prevention. Judith Cranford heads the National Osteoporosis Foundation.

JUDITH CRANFORD:

We need to ensure that when we are younger that people are getting adequate amounts of calcium and engaging in exercise, but that in every phase of the life cycle, there is something that we can do to prevent osteoporosis, to maintain good bone health, and hopefully to ward of potential fractures.

SUSAN DENTZER:

The report notes that most Americans do not consume recommended levels of calcium for their age group. For instance, menopausal women need 1,200 to 1,500 milligrams per day of calcium from foods like dairy products or from calcium supplements.

People also need two hundred to six hundred international units daily of vitamin d, which enables the body to absorb calcium in the first place. A half hour to an hour daily of strength and weight-bearing exercise daily is also critical. In childhood and young adulthood, that helps build and maintain bone mass.

Later, especially after menopause in women, it strengthens muscles and coordination and helps to avert fracture-causing falls. The surgeon general's report makes clear that almost all these recommendations apply equally to men, who make up about one in five Americans with osteoporosis. One of those is 93-year-old James Scanlon, who broke his hip in a fall five years ago.

JAMES SCANLON:

That's the only thing I miss. I loved being able to stand up straight, right? And… Errol Flynn was a stand-up guy, believe me. He could swing a great saber. He could duel. But… yeah, go ahead.

SUSAN DENTZER:

And you wish you looked like that again?

JAMES SCANLON:

Oh, yes, from a stature standpoint, right?

SUSAN DENTZER:

Much less is known about what triggers osteoporosis in men than in women. But lowered hormone levels can play a role, as well as certain prostate cancer treatments, can play a role.

The surgeon general's report also calls on America's physicians to do a far better job counseling patients on osteoporosis prevention. It says not enough recommend bone density screening when appropriate or treat osteoporosis after fractures. Linda Johnson says that's key.

LINDA JOHNSON:

I must tell you that I'm still finding that today. There are still a lot of doctors who don't know. They don't take it as seriously, I think, as they should.

SUSAN DENTZER:

Now Johnson hopes the surgeon general's report will focus far more attention on the hard truth of osteoporosis and prevent millions more cases in the future.