Bone specialist warns of rising fracture risk for older Americans

A bone disease specialist is warning that many Americans are reaching older age with weaker bones, raising the risk that a fall can lead to disability or death. Matthew T. Drake, chief of Endocrinology and Metabolic Bone Disease Services at Hospital for Special Surgery, said in a Fortune commentary that prevention needs more attention before fractures occur.

Drake wrote that nearly 100,000 older Americans fall on a given day. For some, he said, the injury can start a sharp decline that includes a hip fracture, loss of independence or early death.

He argued that many falls are treated as isolated accidents even when weak bones have developed over many years. Drake pointed to less physical activity, more time indoors and lower intake of calcium and vitamin D as factors that can leave the skeleton more fragile.

More than half of U.S. adults over age 50 have low bone mineral density or osteoporosis, according to Drake. Osteoporosis weakens bones and makes fractures more likely, and he said the condition can advance for years without pain or other warning signs.

Hip fractures are among the most serious outcomes. Drake said one in five adults dies within a year after a hip fracture, while many survivors do not return to their previous level of independence.

Care gaps after fractures

Drake said early diagnosis and treatment are central to reducing later injuries, but access to that care is under strain. He wrote that the number of clinicians who commonly manage bone health, including endocrinologists and orthopedic surgeons, is falling short of the needs of a growing at-risk population.

The United States could face a physician shortage of more than 140,000 by 2038, according to Drake. He also said fewer than one in five patients receives appropriate osteoporosis care after a fracture, leaving a chance to prevent another injury unused.

Drake described bone loss as a long-term condition shaped well before old age. He said choices made in a person’s 30s, 40s and 50s can affect bone strength later in life, and he said the problem is not limited to women after menopause.

What Drake recommends

Drake said prevention starts with calcium because the body does not make it. When intake is too low, he said, the body draws calcium from bones, weakening the structure over time.

Most adults need about 1,000 to 1,200 milligrams of calcium a day, according to Drake. He said many people can reach that level through dairy foods or fortified alternatives such as soy or oat milk at meals.

Vitamin D is also needed because it helps the body absorb calcium, Drake said. He identified sunlight, egg yolks, fatty fish and fortified foods as sources, with supplements serving as an option for people who do not get enough from sun exposure or diet.

Drake also urged regular weight-bearing movement, saying bones respond to physical stress. He listed brisk walking, stair climbing, dancing and strength training as examples, and said 30 minutes of weight-bearing exercise on most days can make a difference over time.

Drake said these steps are usually neither costly nor difficult, but they are often overlooked because the consequences of weak bones may take decades to appear. He framed bone health as a public health issue that needs attention before the first serious fall.

This story draws on original reporting from Fortune.