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Close-up: Diane Schneider

Renowned expert on bone health says osteoporosis is ‘silent killer’

Her new book focuses on prevention, treatment

One out of three older men and one out of five older women with hip fractures end up dying within just one year of the injury. This is because the average age when people have hip fractures is in their 80s, so surgery to repair a hip is either not advisable or often leads to complications like pneumonia.

Statistics show that more women die of broken hips and backs each year than from breast cancer.

Why then, is bone health not given the same importance as heart disease or have the same level of awareness that cancer does? It’s because osteoporosis is a silent disease.

The only way to determine if you have it, barring outward signs, is with a bone density scan.

Dr. Diane Schneider, a leading national expert on osteoporosis, co-founded the nonprofit 4BoneHealth with the aim of dispelling ignorance about the disease and creating awareness to educate the public about bone health.

“With aging, there’s bone loss and the underlying tissue becomes thinner and weaker, leading to fragile bones. You can’t tell by looking at them. The majority of spinal fractures are silent, there’s no pain, so you don’t know it’s happening,” said Schneider, who is a retired associate professor of clinical medicine at University of California, San Diego, where she held several positions.

Diane Schneider

She studied medicine at the University of Louisville, trained as an epidemiologist at the Harvard School of Public Health, and completed a residency in internal medicine as well as a fellowship in geriatrics at Emory University.

Originally from suburban Philadelphia, Penn., she has made San Diego her home for the past 21 years. The fact that geriatrics and bone health are both underserved areas is what drew her to the field, she said.

Schneider has written a book, “The Complete Book of Bone Health,” which will be released this month. It presents the latest information on boosting bone health, from prevention to treatment.

Schneider's new book, which covers prevention and treatment of bone diseases.

She explained that certain groups are more prone to bone loss and fractures, based on genetics as well as lifestyle. Older Caucasians are at highest risk, followed by Asians. Latinos have intermediate risk while African-Americans have the lowest risk.

While women are more prone to have fractures, 30 percent of fractures occur in men, so men are not immune, she said.

Schneider emphasized that calcium is important for bone health.

“If you’re not drinking milk, you’re also missing other nutrients, aside from calcium. Whenever possible, natural sources are better than supplements, but you rarely get sufficient vitamin D from natural sources,” she said.

Vitamin D deficiency is increasingly common nowadays.

Schneider pointed out that the sun is the major source of vitamin D, but even in Southern California the ultraviolet radiation may not be sufficient to produce it, especially during the winter months. The use of sunscreen also blocks UV rays, and hence vitamin D absorption.

There are also very few natural foods with high levels of the vitamin. Fish is one of those sources, but she said it’s mainly wild salmon and halibut.

Most of us believe that a glass or two of Vitamin D fortified milk will take care of our nutritional needs, but one glass has only 100 international units (IU) of the vitamin. The recommended daily dose for children and adults under 70 years of age is 600 IU. For seniors above 70, the suggested intake is 800 IU.

The Endocrine Society released a new report suggesting people need much higher quantities, which is why supplements become necessary.

“Good bone health requires sufficient vitamin D, calcium and exercise. For older adults, fall prevention and support is very important,” she said.

For women, menopause leads to the loss of estrogen production, which can result in bone loss unless it’s prevented by the intake of prescription therapy estrogen, Schneider said.

Her new book focuses on showing people how to optimize bone health through out their life, when to get bone density scans, the risk factors for fractures and bone loss, alternative and complementary approaches as well as prescription medicines.

Despite good lifestyle habits, many people still end up having osteoporosis or osteopedia, she explained. For the former, doctors can prescribe FDA approved medicines.

The latter, however, is not a disease but is diagnosed based on bone density.

“What you should be concerned about is the risk factor for fractures. This depends on genetics, family history, your age, habits such as smoking or drinking more than two glasses of any alcohol a day,” she said.

She recommends that men and women above the age of 70 get bone density scans done. It’s also a wise option for pre- and post-menopausal women who are at risk, and even men above 50 with certain risk factors.

“Nearly half of post-menopausal women who are 50 and older and a third of men over 50 will break a bone,” she warned.

In her book, she talks about controversial hot topics, such as the potential adverse effects from prescription medicines. She referred to the media frenzy last year about osteoporosis drugs that actually may cause fractures.

“Atypical thigh bone fractures have been observed in very few people taking some types of osteoporosis drugs. But the risk of an osteoporotic fracture is much, much greater than an atypical fracture. So the bottom line is that this risk should not prevent some one from starting osteoporosis treatment,” she emphasized.

Schneider said that although osteoporosis is a silent disease, fractures are not inevitable.

“By increasing awareness and knowledge, you can decrease your risk, by making bone health a conscious part of your every day routine.”

-Nagappan is a San Diego-based freelance writer.

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