Jane Glenn Haas
McClatchy Tribune Newspapers
December 23, 2009
Now, I know that a hip replacement is pretty routine. But what puzzles me is why I have this problem at a time when modern medicine has tools - from pills and potions to exercise regimens - designed to prevent or minimize bone and joint problems.
What didn't I do that I should have done?
Turns out I'm not alone in wondering why bone problems don't get solved sooner.
Dr. Richard Dell, an orthopedic surgeon with Kaiser Permanente Group in Bellflower, Calif., asked himself why osteoporosis is a major medical problem affecting millions of Americans. And fragility fractures affect another 1.5 million people, a figure reaching epidemic proportions, Dell says.
"There is a huge cost associated with osteoporosis in terms of morbidity, mortality and the financial impact on society," writes Dell, lead author of a study on osteoporosis and the role of the orthopedic surgeon, just published in The Journal of Bone and Joint Surgery.
He concludes that physicians need to be more aggressive in treating for osteoporosis.
Without treatment, patients suffer. For example, the most devastating complications are hip fractures, with 24 percent of the patients ending up in nursing homes, 50 percent never reaching their previous functional capacity and 25 percent dead a year after the fracture, he says.
No wonder I'm interested.
Q. Why don't we hear more about osteoporosis?
A. It's a silent disease. Until there is a fracture, there is no manifestation. You would think that people would have a higher interest because it is treatable and preventable. But people think they should have symptoms before they have the disease.
Q. How can I find out if I have osteoporosis?
A. A very low dose X-ray - it takes about two minutes to do the whole study. The amount of radiation is low, lower than a flight from L.A. to New York. The treatment also is low-risk.
Q. Let's talk about hip fractures. Is there a difference between men and women?
A. When a man has a hip fracture, he's at twice the risk of a woman. The reason is that men will almost always turn out to have osteoporosis. A woman is postmenopausal and could have hormonal problems. A high percentage of people who have hip fractures are smokers, by the way.
Q. You think the numbers can be changed if patients are more aware of treatment?
A. It's one of those things where the general population needs to push harder. We think we can lower the hip fracture rate by 25 percent. In a well-controlled study where patients took their medications and did exercises, 50 percent became a reachable goal, so 25 percent is not like shooting for the moon. But you have to be willing to identify the population.
I have to plug Kaiser here because we have 12 centers and we compete against each other. Everybody wants to be the best. Competition can be a wonderful thing in medicine. We identify, treat and track our patients to improve outcomes.
Q. OK. But the average patient is not in a Kaiser program.
A. Think about osteoporosis and potential treatments. Like Fosomax.
Calcium and vitamin D cost more than Fosomax. It's crucial that - in addition to medications like Fosomax that can help build bones, if that's what you need - people forget to do the simple things also. Like watch your diet, take calcium, exercise, stop smoking.
Q. Bones get old.
A. Osteoporosis is not an inevitable disease of old age. If it's dealt with early in life, the problem can be avoided. If the patient hasn't dealt with it, more aggressive treatment might be necessary. The truth is, we start building calcium when we are kids. We store that calcium and at age 30 or 35, we start to gradually lose the calcium we have stored. The loss is rapid around menopause, which is why women more than men are at risk.
Q. Why don't physicians talk more about this with patients?
A. They are so focused on fractures they forget the cause of the fractures. The job is not done when we just take care of the fractures. Ninety percent of the fractures in people older than 65 are secondary to osteoporosis. So we miss the boat. Physicians need to be more active in osteoporosis disease management.
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