BONE MASS IN PHYSICIANS: DISCUSSION

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DISCUSSION

In this study, 68% of the physicians had low bone mass (12% had osteoporosis and 56% had osteopenia). We are unable to identify similar, published data on bone mass in a cohort of physicians; thus, this is a unique study. The results of NHANES III showed that the prevalence of low bone mass increases with age. In the general population, the prevalence of reduced bone mass in women 50-59 years old was 37% but increased to 87% among women 80 years and older. Our study revealed that osteoporosis was present in 33% of the cohorts in both the age group from 30-39 years old and the >60 years old group. This may be explained by the number of subjects in these two groups. These were the two largest age groups. It is difficult to compare NHANES III data with the data of this physician study. Our cohort was younger (mean age of 42 years old). Twenty-five percent of the group was under the age of 39 years. We are unable to find data on a young group with which to compare our data. Also, this study is a pilot study done on the population in an urban hospital with few Caucasian physicians. The National Osteoporosis Risk Assessment study (NORA), the largest recently reported study of osteoporosis tablet that included minority women, showed that the risk of osteoporosis was 1.56 times greater for Asian women, 1.31 times greater for Hispanic women and 45% lower for African-American women, compared to Caucasian women. Other studies of minority groups showed that the risk for osteoporosis is low in African Americans. Our study was not designed to evaluate low bone mass density in various ethnic groups. However, in this study, more low bone mass density was evident in African Americans and Asians than in other ethnic groups. The Asians and African physicians had the largest percentage of persons with osteopenia (61%); they had no one with osteoporosis. For the Asians, the osteopenia may reflect the early start of osteoporosis (their mean age was 48 years), or it may be secondary to nutritional or genetic factors, or to a combination of age, nutrition, and genetic factors. Studies show that the peak bone mass attained at the end of adolescence is one of the principal factors that determines bone mass later in life. The finding of osteopenia in this group of young adult physicians strongly suggests that with continuous loss of bone mass they will progress to osteoporosis at a later age. One study indicated that Japanese women had lower peak bone mass than white non-Hispanic women. It may be that the Asian physicians studied had decreased peak bone mass. It should also be noted that in our study, one out of the 31 Asians was a strict vegetarian, and 10% of the 31 were lactovegetarians.

The reasons for the high prevalence of low bone density among physicians are unknown. We have investigated variables, such as calcium, coffee and tea intake; BMI; and exercise. cheap cialis canadian pharmacy

Calcium intake plays an important role in the maintenance and development of bone mineral density. Conclusions from meta-analysis studies have shown that adequate calcium intake—whether dietary or supplemental—protects the skeleton and reduces fracture risks. The daily .calcium requirement also varies among females, males, and different age groups. However, in our study population, only 27% of the physicians had adequate calcium intake. Although osteoporosis and osteopenia occurred in 52% of the physicians who had low calcium intake, there was no significant relationship between the presence of low bone mass and calcium intake in this study group. There are several possible reasons for these data. These include the fact that this was an observational study with a small study cohort that evaluated the diet variables over a restricted time period. Reported calcium intake reveals limited information about current consumption, whereas bone mass is the accumulation of minerals and nutrients after many years of dietary changes. In most observational studies of nutritional relationships, one of the most serious weaknesses is the failure of the subjects to accurately assess their intake.

The WHO Study Group and others consider that high caffeine intake is a risk factor for reduced bone density in women. However, Hegarty et al. demonstrated that older women who drank tea had higher bone mineral density, and concluded that tea drinking may protect against osteoporosis. In our study, there was no significant correlation between coffee or tea intake and bone mineral density. Data on intake of caffeinated drinks or supplements was not included, because of the lack of data in established studies defining the amount of caffeine in these substances that is likely to harm bone density. Despite the clear increase of bone density associated with regular weight-bearing exercise, only 20% of the American population participate in a regular weight-bearing exercise program. An assessment of modifiable high-risk behaviors among family physicians in the United States determined that only 54% engaged in regular exercise. In our study population, only 33% of the physicians exercised regularly. Although our data revealed a high prevalence of osteoporosis and osteopenia among physicians who did not engage in regular adequate exercise (70%), there was no correlation between low bone mineral density and exercise. Study participants gave several explanations for their failure to exercise—such as lack of time, weather changes, and safety of the environment. The availability of time was the primary reason given by most physicians for not exercising regularly. During the training years, many physicians are obliged to spend most of the time studying, usually indoors. Whether or not this time during the training years is responsible for the decreased bone mass found in this study remains a question.

We acknowledge the limitations and weaknesses of this report. This was a small observational, cross-sectional but not randomized investigation. Budgetary constraints obviated the determinations of serum calcium, vitamin-D levels, and serum markers of bone turnover.
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CONCLUSION

This unique study demonstrated a high prevalence of reduced bone density in the physician cohort studied. It strongly suggests the need to define bone mineral density and the variables that influence its development in a larger cohort of young, ethnically diverse clinicians and other health workers.