The U.S. Surgeon General issues first ever report on nation’s bone health
Appeared in Osteoporosis Action 3/2004
Contributed by Prof. Ethel Siris, IOF Board member, Department of Medicine, College of Physicians and Surgeons of Columbia University, and director of the Toni Stabile Osteoporosis Center of the Columbia-Presbyterian Medical Center, New York.
With his landmark report, US Surgeon General Dr. Richard Carmona issued a call to action to put into practice the substantial knowledge that has been gained in recent years in order to reduce the human suffering and economic costs that result from fragili
A landmark report released in October 2004 by the Surgeon General of the United States, forcefully brings to the attention of the American people the serious public health crisis created by osteoporosis and related fractures.
After informing the public and healthcare providers that the state of the nation’s bone health is not good, Surgeon General Dr. Richard Carmona issued a call to action to put into practice the substantial knowledge that has been gained in recent years in order to reduce the human suffering and economic costs that result from fragility fractures.
The comprehensive 400-page report was produced by a large group of scientists, clinicians and public health specialists who are leaders in the bone field, working together with several US government agencies. The report provides an extensive body of information about osteoporosis as well as about other bone disorders such as Paget’s disease of bone, hyperparathyroidism, osteogenesis imperfecta, renal bone disease and skeletal complications of malignancy.
Substantial publicity about the report followed its release and the expectation is that it will be widely distributed and influential.
Well-referenced and evidence-based, the report is divided into six sections. The first defines both bone health and disease in an easy to understand style designed for the public at large. The second part reviews the less-than ideal state of bone health in the U.S. today and explains the seriousness of the problem. Succeeding sections discuss what we know today about bone health and what can and should be done to improve the situation – focusing on actions needed from individuals, health care providers and from the overall health care system.
Prevention of osteoporosis a major theme
The final section of the report discusses the hopes and possibilities for the future. Prevention of osteoporosis is a major theme, focusing on the need for a healthy lifestyle, calcium and vitamin D deficiency, and adequate exercise at every age. Risk factors for osteoporosis and fracture in men and women and all ethnic groups, the role of bone density testing, and the data on the established pharmacological agents for prevention and treatment of osteoporosis are all carefully reviewed.
An influential health policy document which defines standards of care
A Surgeon General’s report has enormous influence because it provides a scientific body of evidence to both individuals and clinicians with a level of legitimacy, credibility and urgency underscored by the authority of the country’s chief physician.
One of its most important messages is that we have the knowledge base at this time to make a great difference in people’s lives, but that we have to narrow the substantial gap between what we now know about bone biology and skeletal health and what we actually do in medical practice to prevent osteoporosis and fractures. In essence, it defines standards of care.
The initial request for a Surgeon General’s Report was brought to the U.S. Congress – the body that commits government funds for the creation and dissemination of such a major undertaking – by a coalition of advocacy and scientific organizations led by the National Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Paget Foundation for Paget’s Disease of Bone and Related Disorders and Osteogenesis Imperfecta Foundation. Their persuasive efforts led the Congress to authorize the Surgeon General to proceed, and this major health policy document is the result.
It is everyone’s hope that the messages in this report will be heard and understood by millions of people, and that a real and meaningful improvement in bone health will be the ultimate outcome.
The full report, executive summary, and a brochure for patients, are available online at www.surgeongeneral.gov. Printed copies of the documents can also be requested.
Startling facts from the U.S. Surgeon General’s report
The Surgeon General warns that by 2020, half of all American citizens older than 50 will be at risk for fractures from osteoporosis and low bone mass if no immediate action is taken by individuals at risk, doctors, health systems, and policymakers. U.S. statistics also show:
- Each year, roughly 1.5 million people suffer a bone fracture related to osteoporosis.
- About 20% of senior citizens who suffer a hip fracture die within a year of fracture.
- About 20% of individuals with a hip fracture end up in a nursing home within a year. Hip fractures account for 300,000 hospitalizations each year.
- The direct care costs for osteoporotic fractures alone are already up to $18 billion each year. That number is expected to increase if action to prevent osteoporosis is not taken now.
