BETHESDA, Md. — It seems everyone has an older relative with a broken hip, or has noticed with a sense of puzzlement that their parents seem to be shrinking.
Because these experiences are so universal there is the temptation to dismiss them as inevitable. But the fact is that osteoporosis, the disease of bone-thinning found mostly in the elderly, is a debilitating, expensive and sometimes almost fatal ailment that doctors are scrambling to prevent and treat in better ways.
About 700 medical practitioners and scientists from around the world gathered at a standing-room-only conference on osteoporosis at the National Institutes of Health here last week. They discussed every aspect of the subject, and almost always, they argued.
Some facts that nobody challenged are that osteoporosis caused 247,000 hip fractures in 1985, and the total cost of treating such injuries was estimated to have been between $7 billion and $10 billion in 1986, according to conference co-chairman Dr. William Peck of the Jewish Hospital of St. Louis.
For the Record
Los Angeles Times Wednesday February 18, 1987 Home Edition View Part 5 Page 2 Column 6 View Desk 1 inches; 35 words Type of Material: Correction
Due to an editing error, a story on osteoporosis in Tuesday's View section misstated the number of women who will have one or more fractures of the vertebra is 4%. Unpublished data from the Mayo Clinic in Rochester, Minn., suggests the figure is 40%.
Osteoporosis is also the major cause of a pattern in the elderly--especially women--whose shoulders hunch forward as a result of deterioration in their spines, giving them the stooped appearance associated with extreme old age.
With life expectancy rising and the population rapidly aging, the incidence and financial costs of osteoporosis are expected to multiply rapidly and place an enormous burden on the already shaky American health system in the near future, especially when the ever-monitored baby boomers begin breaking hips in about 20 years.
More findings gathered from various conference presentations:
-- Of those who break their hips, only 25% will experience a full recovery. Half will need some assistance in carrying out their daily activities for the rest of their lives, and one-fourth will remain so disabled that they will need to be placed permanently in a nursing home.
-- More than 12%, and perhaps as many as 20%, of those who suffer hip fractures will die within a year of their injury. This does not mean that people die of hip fractures, but that such a long, painful and disabling illness experienced by older people may depress them and leave them more vulnerable to other ailments, such as heart failure.
-- Of those individuals who live to age 90, one-sixth of the men and one-third of the women will suffer a hip fracture.
One or More Fractures
Unpublished data from the Mayo Clinic in Rochester, Minn., Peck added, suggests that 4% of all women will have one or more fractures of the vertebra. Dr. L. Joseph Melton of the Mayo Clinic pointed out that while most hip fractures are the result of falling, vertebral fractures usually happen spontaneously--that is, during a time of little or no movement--in a person with osteoporosis.
The participants seemed to agree on only two things: that much more research needs to be funded in this area, and that the public needs to pay more attention to osteoporosis.
"This is not a consensus conference," Peck said afterward. "We did not force ourselves to form a consensus on issues where none was possible."
Dr. Maria Greenwald of the Osteoporosis Medical Center in Beverly Hills said: "The thing that struck me was that the same questions were asked over and over and over: When to use calcium, when to use estrogen, when do you screen? There's a lot of confusion out there among physicians, as much as among lay people."
While there are no easy answers, there are some things people of all ages can do to help prevent osteoporosis. These include regular exercising, not smoking, consuming no more than two alcoholic beverages a day, avoiding extreme thinness and including 1,000 milligrams of calcium in the diet per day.
There is controversy over how much and what kind of exercise is appropriate to prevent or minimize osteoporosis, with some studies pointing to load-bearing exercise having the best bone-building effect. Aerobic exercise is also thought to help, with activities that subject the skeleton to weight-like stress best. Swimming is the least relevant exercise but better than none at all, the experts agreed.
Because it is nearly impossible to set up studies that follow large numbers of people from their 20s into their 80s, doctors cannot conclusively state that taking supplements over a lifetime will prevent fractures. But, pressed on the subject, most doctors seem to agree it is probably a good idea to take a supplement.
"It is easy to recommend that 1,000 milligrams of calcium should be taken in each day for the entire population, and this can be achieved by dietary methods," said Dr. Lawrence Riggs of the Mayo Clinic, chairman of the conference's calcium panel. By dietary methods, Riggs meant eating foods high in calcium, such as leafy green vegetables, canned salmon, sardines with bones and dairy products. Drinking a quart of skim milk daily would provide 1,200 milligrams of calcium.