The world of American Bone Health

Executive Director of American Bone Health speaks to us about how bone health is the foundation of a health life.

American Bone Health teaches people how to build and keep strong and healthy bones for life with practical and up-to-date information and resources to inspire them to prevent bone loss, osteoporosis and fractures. We spoke to Executive Director, Kathleen Cody, about the importance of bone health.

Can we start by you telling us a bit about bone health, and what this means? What is the current state of bone health in the US?

From my perspective, bone health is the foundation of a healthy life. The bones help us get around, they’re a storehouse for minerals and they protect our organs. Bones do all kinds of important things that people don’t really think about. Bone health is about building strong bones and maximizing them when you’re a kid. It is also about being strong, active and independent as we age. As we age, it is really important to protect against bone loss and fractures. Recently we did a survey of consumers here in the US and we asked them if they had a plan for their bone health and over half of them said no because they didn’t think bone health was important; that is a real problem that we have here in the US.

What are some of the biggest risks when it comes to bone health, and how can these be avoided/treated?

There are a couple of them on both ends of the lifespan. The first one is that kids are not maximising their peak bone mass; they’re not getting the right kind of nutrition and physical activity to build as much bone as they can. By the time you’re 25 to 30 years old, you’ve got all the bone density that you’re going to have for your entire lifetime.

If you can’t maximize that, you’re going to start at a lower threshold of bone density when you start losing bone as you get older. The thing that we can do to change that is educate parents and help them understand how important bone building is when their children are in their teens, and help the children know what kind of choices to make when it comes to food and physical activity so that they’re doing good things for their bones and not bad things.

The other risk we have here in the US is that after years of steady decline of hip fractures, since about 2002 we’re seeing an increase in hip fractures. The researchers that have looked at this data think there have been 36,000 additional hip fractures since 2012. They believe this is because we’re not doing enough bone density screenings, and people are not going on osteoporosis treatment when they need to be treated. In the US right now, we are working on policy changes to increase the reimbursement for bone density testing, so that people who need it are screened. Bone density screening is key because it triggers bone health management by physicians here in the US.

What would you say is one the biggest misconceptions when it comes to bone health?

It’s really interesting to me that people think of their bones as a hard, lifeless thing. In fact, bones are living and actively metabolic tissue. Moreover, because of the removal of old bone and the creation of new bone, your skeleton remodels about every seven to 10 years. It’s really a fascinating structure that people don’t realise is impacted by things like other diseases or certain medications that they may take.

As an example, in the US, we have a huge number of people with diabetes. We’re continuing to learn more about the impact of a high sugar load on the skeleton. Generally, people with diabetes will have denser bones which appear to be strong when they actually tend to be more fragile – they break more easily. Therefore, people really need to understand that their bones are designed to be strong, however they cannot withstand the bad things that we put on them.

What is the work and role of American Bone Health? Can you tell us a bit about the Fracture Risk Calculator?

American Bone Health does public education; we do that by training volunteers to go into their communities and educate their friends and families about bone health and what they can do to build and maintain strong bones. We provide volunteer Peer Educators with programmes and presentation materials. Our content is evidence based and reviewed by our Medical and Scientific Advisory Board.

The American Bone Health Fracture Risk Calculator is a really important tool for educating people about their chances of breaking a bone. It was developed by a member of our Medical and Scientific Advisory Board. The results from the calculator are very similar to the World Health Organization (WHO)’s ‘FRAX’, but it is slightly different because it’s based on US validation. The calculator looks at a number of risk factors that can increase your chances of breaking a bone, and this includes whether you’ve had a previous broken bone and whether your parents have had a hip fracture. The results are plotted on a graph that illustrates whether the person is at low, moderate or high risk. It’s a coloured graph, and it really can help people understand what they need to do next. Once the consumer gets their results, they get a worksheet of steps to speak with their doctor about.

Where would you like to see Americas bone health in five years’ time? What role would you like to see American Bone Health play in this?

Personally, I would really like to see Americans embrace their bone health and not take it for granted. It’s really important to live a long and active life, and I’d like to be able to help people prevent bone problems in the future. American Bone Health is a convener and a collaborator, and we’re trying to engage with community-based and government-based organizations to educate and engage with them, and give the public the tools and steps that they need to take care of their bone health.

Kathleen Cody
Executive Director
American Bone Health

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