Bone Health and Osteoporosis: A Report of the Surgeon General

Part Four: What Can Health Care Professionals Do To Promote Bone Health?

This part of the report describes what health care professionals can do with their patients to promote bone health. It seeks to dispel the belief among some health professionals that bone disease and fractures are a natural consequence of aging and that little can be done about it.

Chapter 8 emphasizes the need for health professionals to evaluate potential risk factors for bone disease and to promote bone-healthy behaviors in all patients. The chapter stresses, however, that comprehensive assessments that include diagnostic testing should be focused on those deemed at high risk of bone disease. To assist in this process, the chapter examines the potential risk factors for bone disease, highlights red flags that signal the need for further assessment, and reviews the use of formal assessment tools to determine who should get a bone density test and who is at risk of fracture. It includes real-life vignettes that highlight the need for the medical profession to become aware of the potential for severe osteoporosis to develop in younger men and women.

Chapter 9 focuses on preventive and therapeutic measures for those who have or are at risk for bone disease. It reviews a “pyramid approach” to treating bone diseases and to preventing falls and fractures, with maintenance of bone health through calcium, vitamin D, physical activity, and fall prevention representing the base of the pyramid for all individuals, including those with bone disease. This chapter also covers the second and third levels of the pyramid, which relate to addressing and treating secondary causes of osteoporosis and use of pharmacotherapy in appropriate individuals. One of the key messages of the chapter is that there are effective treatments available that can increase bone mass and/or reduce the risk of fractures for most patients who have or who are at high risk of getting osteoporosis. The chapter reviews the evidence and provides guidance on currently available anti-resorptive therapies, anabolic therapies, and hormone therapies, and offers a glimpse into future directions for treatment of osteoporosis. Finally, the chapter highlights treatment options for other bone diseases that are related to osteoporosis.

Chapter 10 “puts it all together” for health care professionals by translating the research into practical advice for preventing, diagnosing, and treating bone disease in patients of all ages. All health care professionals, especially primary care practitioners, have the opportunity and responsibility to dedicate themselves to promoting awareness of factors that influence bone health, identifying patients at risk of bone disease, and providing lifestyle and pharmacologic interventions where appropriate.

Published: October 14, 2004

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