Bone Health and Osteoporosis: A Report of the Surgeon General

Preface From the Surgeon General, U.S. Department of Health and Human Services

As Surgeon General, my primary role is to provide the American people with the best scientific information available on how to improve health and reduce the risk of illness and injury. This first-ever Surgeon General’s Report on bone health and osteoporosis provides much needed information on bone health, an often overlooked aspect of physical health. This report follows in the tradition of previous Surgeon Generals’ reports by identifying the relevant scientific data, rigorously evaluating and summarizing the evidence, and determining conclusions.

A healthy skeletal system with strong bones is essential to overall health and quality of life. Yet, today, far too many Americans suffer from bone disease and fractures, much of which could be prevented. An estimated 10 million Americans over age 50 have osteoporosis (the most common bone disease), while another 34 million are at risk. Each year an estimated 1.5 million people suffer an osteoporotic-related fracture, an event that often leads to a downward spiral in physical and mental health. In fact, 20 percent of senior citizens who suffer a hip fracture die within 1 year. One out of every two women over 50 will have an osteoporosis-related fracture in their lifetime, with risk of fracture increasing with age. Due primarily to the aging of the population and the previous lack of focus on bone health, the number of hip fractures in the United States could double or even triple by the year 2020.

However, the evidence in this report is clear: Hope is not lost. Over the past several decades, scientists have learned a significant amount about the prevention, diagnosis, and treatment of bone disease. Our next and most critical step is to transfer this knowledge from the research laboratories to the general population.

One of my priorities is to promote disease prevention by helping Americans take actions to make themselves and their families healthier. The good news is that regarding bone health, these steps are clear—with appropriate nutrition and physical activity throughout life, individuals can significantly reduce the risk of bone disease and fractures. Health professionals can also make significant improvements in our Nation’s bone health by proactively assessing, diagnosing, and treating at-risk patients and then helping them apply this scientific knowledge in their everyday lives.

However, individuals and health professionals acting alone will not make a long-term difference. This brings us to the primary message of this report: A coordinated public health approach that brings together a variety of public and private sector stakeholders in a collaborative effort is the most promising strategy for improving the bone health of Americans. This report calls for the development of a national action plan to achieve improved bone health, and it highlights the unique and valuable perspectives that key stakeholders can bring to this effort. While government ought to be a part of the plan’s development, leadership must be shared among the many public, private, nonprofit, academic, and scientific stakeholders.

Over the past 2 years, I have worked to improve the health literacy of Americans; that is, to ensure that individuals can access, understand, and use health-related information and services to make appropriate health decisions. To that end, a short, easy-to-read companion piece to this report has been developed. Available in English and Spanish, this People’s Piece takes the best scientific information available in this report and provides Americans with important, practical information on how they can improve their own bone health.

I am encouraged by the participation of so many people and organizations in developing this report, and I would like to thank them for their willingness and eagerness to assist us in gathering the best scientific information available. I am confident that their passion will be a catalyst for action. Working together, we can take real steps to improve the bone health status of Americans. Our reward for this effort will be to prove the forecasters wrong—instead of seeing ever-increasing numbers of individuals suffering from the agony of bone disease and fractures, we will see the day when fewer and fewer Americans bear this burden.

Richard H. Carmona, M.D., M.P.H., FACS
Surgeon General

Published: October 14, 2004

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