RADM Kenneth P. Moritsugu, M.D., M.P.H.

U.S. Deputy Surgeon General

Dr. Moritsugu conveyed regrets on behalf of the Surgeon General, VADM Richard Carmona, M.D., M.P.H., F.A.C.S., who was unable to be at the meeting due to an emergency. Dr. Moritsugu read a statement from Dr. Carmona emphasizing the importance of addressing bone disease, a silent killer that robs too many Americans, especially women, of health throughout their lives. While affecting more than one in 10 Americans, bone diseases such as osteoporosis, Osteogenesis Imperfecta (OI), and Paget’s Disease are largely unfamiliar to the majority of Americans. Physicians, who typically know of these diseases, are often unaware of appropriate management and treatment for them. And like many chronic diseases, osteoporosis–the most prevalent bone disease–is largely preventable. Dr. Carmona’s top priority as Surgeon General is to prevent debilitation and premature mortality from all causes, including bone disease and injury, in Americans.

Dr. Moritsugu emphasized the importance of taking a public health approach to bone disease. Bone loss usually develops slowly over a lifetime. Only recently has the extent to which it affects Americans (especially women) become clear. An estimated 34 million Americans have reduced bone mass and 10 million have osteoporosis. While 80% of those with osteoporosis are women, men also suffer from bone disease. In fact, half of women and one quarter of men over the age of 50 will have an osteoporosis-related fracture sometime during their lifetime. The disease affects all races and ethnic groups; Asian women, non-Hispanic white women, Hispanic women, and African-American women over the age of 50 are all at risk for osteoporosis, although to varying degrees. Yet despite these statistics, the disease remains little understood by the general public (including those at the greatest risk) and the medical community. The vast majority of women and men with the disease remain undiagnosed and untreated today. As a result, osteoporosis imposes a huge toll on its victims. Roughly 1.5 million individuals will suffer an osteoporosis-related fracture this year. Up to 20% of those suffering hip fractures will die from injury-related complications within a year.

The good news is that the risk factors for osteoporosis are well understood and in many cases controllable. Risk factors include improper diet, lack of exercise, smoking, excessive use of alcohol, being female, being thin or having a small frame, advanced age, a family history of the disease, and a history of anorexia nervosa or low calcium intake. Dr. Moritsugu emphasized the importance of taking all these risk factors into account in developing a prevention strategy, and he highlighted the need for Americans to stop smoking and drinking, to exercise and eat well, and to get the appropriate vitamins and minerals, including calcium, into their diets. These changes will help reduce the incidence of many other diseases as well. This workshop and the upcoming Surgeon General’s Report may be seen as evidence of the high priority the Surgeon General is giving to the promotion of bone health and prevention of bone disease.

Eve Slater, M.D.

Former Assistant Secretary for Health

Dr. Slater conveyed the gratitude of Tommy Thompson, Secretary of the Department of Health and Human Services (DHHS), to workshop attendees. Dr. Slater noted that Secretary Thompson believes that osteoporosis and bone health are both long overdue for this level of attention (i.e., a Surgeon General’s Report). Since 1964, the Surgeon General has been communicating directly with the public on important health issues. The first report on smoking had a dramatic impact on public perceptions and on smoking rates. A Gallup survey in 1958 found that only 44% of Americans believed that smoking caused cancer. By 1968 (four years after the release of the Surgeon General’s Report on smoking), that figure had increased to 78%. (Part of the increase may have been driven by the 1965 Congressional mandate that cigarette packages contain a health warning; this legislation was also a reaction to the report.) More important, perhaps, smoking rates have fallen by roughly 50% since the report was issued.

Other reports by the Surgeon General have also had a major impact. The 1986 report on HIV/AIDS met with great acclaim and instant controversy. It materially affected both the public’s and the medical profession’s conceptions of the disease, literally changing the mindset of the nation. In closing, Dr. Slater called on workshop attendees to use their collective memories, superb reasoning skills, and imagination in proposing strategies to improve bone health.

Joan A. McGowan, Ph.D.

National Institute of Arthritis and Musculoskeletal and Skin Diseases

Dr. McGowan will serve as senior scientific editor for the Surgeon General’s Report. She highlighted several of the key challenges facing the bone field, including finding ways to take actions inside and outside of health care settings to promote prevention, screening, and treatment. She called on the field to look outside of bone health for promising models and best practices. She urged workshop attendees to keep in mind the myriad forms of bone disease in their efforts. While osteoporosis is naturally the primary focus (due to its prevalence and the existence of substantial knowledge about prevention and treatment), other, rare bone diseases can also benefit from early diagnosis and intervention. Dr. McGowan noted that the U.S. is now a formal part of the Decade of the Bone and Joint, an international effort to raise awareness among the public and the medical community about all musculoskeletal diseases. The Surgeon General’s Report will play an important role in this international effort.

Lawrence G. Raisz, M.D.

University of Connecticut Health Center

Dr. Raisz will serve as a scientific editor for the upcoming report. Noting that he and his peers (affectionately known as “bone heads”) tend to focus on how to diagnose and treat bone diseases, he is especially enthusiastic and excited about the focus on prevention and public health that will be a centerpiece of the Surgeon General’s Report. Dr. Raisz believes that the goal of the report should be to change the mindset about the disease. But because the problems are big, complex, and far-reaching, a simple “here’s-what-to-do” prescription will not work. Getting the message out, in fact, will be a challenge. But the workshop is an excellent start, as it will produce immediate action plans. The report will build on the workshop by collating and verifying meaningful, effective strategies that can be implemented to prevent and treat bone disease throughout an individual’s life (from “cradle to fracture”). The ultimate goal from this effort should be to enact a vast array of changes that collectively serve to make bone disease a thing of the past. Achieving this goal will require the collective hard work of a variety of different stakeholders.