what it means to

you

The 2004 Surgeon General’s Report on

Bone Health and Osteoporosis

The 2004 Surgeon General’s Report on

Bone Health and Osteoporosis
About This Surgeon General’s Report

The Surgeon General is the nation’s highest-ranking public health officer. The 

President of the United States appoints the Surgeon General to help protect 

and promote the health of all Americans. 

The Surgeon General gives Americans the best scientific information available 

on how to improve their health and reduce their risk of illness and injury. This 

booklet is about risks to our bones. The Surgeon General says that Americans 

need to do much more to protect their bone health. 

The 2004 Surgeon General’s Report on Bone Health and Osteoporosis was 

prepared by some of the country’s top scientists, doctors, and public health 

experts. The full report is more than 400 pages long and took more than 2 years 

to complete. It is written for a scientific audience. However, Surgeon General 

Richard H. Carmona believes that the findings are very important to everyone. 

This booklet explains what the report says and what it means to you.

Suggested citation: U.S. Department of Health and Human Services. The 2004 Surgeon General’s Report on Bone Health and 

Osteoporosis: What It Means To You. U.S. Department of Health and Human Services, Office of the Surgeon General, 2004.
Your bone health may be at risk. By 2020 half of all Americans 

over 50 will have weak bones unless we make changes to our diet 

and lifestyle. People who have weak bones are at higher risk for 

fractures. Americans are living longer, and this means that our bones need 

to stay strong so we can be active and enjoy life. Strong bones begin in 

childhood. With good habits and medical attention when needed, we can 

have strong bones throughout our lives.

Thirty years ago, little was known about bone disease. Even many doctors 

believed that weak and broken bones were just a part of old age and 

could not be avoided. Today we know that this is not true. 

The Surgeon General wants you to know that you can improve your 

bone health by getting enough calcium, vitamin D, and physical 

activity. If you have 

osteoporosis or another 

bone disease, your doctor 

can detect and treat it. 

This can help prevent 

painful fractures. If you 

break a bone after the age 

of 50, this could be the 

first sign of weak bones.

1

...with good 

habits and 

medical 

attention 

when needed, 

we can have 

strong bones 

throughout 

our lives.

Poor bone health is common and costly.

People placed

in nursing

homes

180,000

Visits to the

doctor’s office

2.6 million

Trips to the

emergency

room

800,000

Hospitalizations

500,000

Fractures

from

osteoporosis

1.5 million

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

People hurt each year by osteoporosis
Weak Bones Hurt Us All

Broken bones are very painful at any age. Each year 1.5 million older 

people in this country suffer fractures because their bones have become 

weak. For older people, weak bones can be deadly. 

If you are elderly, a broken hip makes you up to four times more likely 

to die within three months. If you survive, the injury often causes your 

health to spiral downward. One in five people with a hip fracture ends 

up in a nursing home within a year. Many others become isolated, 

depressed, or frightened to leave home because they fear they will fall. 

The cost of weak bones to 

Americans, their families, 

and our country is huge. 

The medical expense for 

treating broken bones from 

osteoporosis is as high as 

$18 billion each year. The 

cost of care for these patients 

and the work that is lost 

adds billions more.

$18 billion is a stack of dollar bills 1,119 

miles high, or farther than the distance 

from New York to St. Louis, Missouri.

Caring for bone fractures from 

osteoporosis costs America 

$18 billion each year.

2

“

”

One in 

five people 

with a hip 

fracture 

ends up in 

a nursing 

home 

within a 

year.
3

Why Healthy Bones Are Important to You

Strong bones support us and allow us to move. They protect our heart, 

lungs, and brain from injury. Our bones are also a storehouse for vital 

minerals we need to live. Weak bones break easily, causing terrible pain. 

You might lose your ability to stand or walk. And as bones weaken, you 

might lose height. 

Silently and without warning, bones may begin to weaken early in life if 

you do not have a healthy diet and the right kinds of physical activity. 

Many people already have weak bones and don’t know it. Others are 

making choices that will weaken their bones later. 

There are several kinds of bone disease. The most common is osteoporosis. 

In this disease, bones lose minerals like calcium. They become fragile and 

break easily. With osteoporosis, your 

body’s frame becomes like the frame 

of a house damaged by termites. 

Termites weaken your house like 

osteoporosis weakens your bones. 

If you have severe fractures from 

osteoporosis, you risk never walking 

again. Weak bones can break easily. 

This can be fatal.

Osteoporosis causes 

weak bones.

Normal

Bone

Bone with

Osteoporosis

Bones may 

begin to 

weaken 

early in life. 

Prevent 

this with 

a healthy 

diet and the 

right kinds 

of physical 

activity.
“

Fragile bones are not painful at fi rst. Unfortunately, most people don’t 

realize they have weakened bones until one breaks. By that time, it is 

hard to make your bones strong again. 

The good news is that you are never too old or too young to improve 

your bone health. There are many things you can do to keep bones 

strong and prevent fractures. At all ages, a diet with enough calcium 

and vitamin D, together with weight-bearing physical activity every day, 

can prevent problems later. You can work with your doctor to check out 

warning signs or risk factors. When you are older, you can have your bones 

tested and take medicine to strengthen them.

The bad news is that few people follow the steps known to strengthen 

and protect their bones. That’s the main reason for the Surgeon General’s 

Report on Bone Health and Osteoporosis. Americans need to know the 

dangers of bone weakness and do more to prevent it.

”

...you are 

never too 

old or too 

young to 

improve 

your bone 

health.

4

Weak bones 

cause the 

spine to 

collapse.

Fragile bones are not painful at first. Unfortunately, most people don’t 
5

Don’t Risk Your Bones

Many things weaken bones. Some are outside your control. If you have a 

family member who has bone problems, you could also be at risk. Some 

medical conditions can also make you prone to bone disease. 

There are some things you can control:

● Get enough calcium and vitamin D in your diet at every age.

● Be physically active.

● Reduce hazards in your home that could increase your risk of falling 

and breaking bones. 

● Talk with your doctor about medicines you are taking that could 

weaken bones, like medicine for thyroid problems or arthritis. Also 

talk about ways to take medicines that are safe for bones. Discuss ways 

to protect bones while treating other problems.

● Maintain a healthy weight. Being underweight raises the risk of 

fracture and bone loss.

● Don’t smoke. Smoking can reduce bone mass and increase your risks 

for a broken bone.

● Limit alcohol use. Heavy alcohol use reduces bone mass and 

increases your risk for broken bones.

fastfact Many types of physical activity can 

contribute to bone health, but most 

people are not active enough.

Staying 

active helps 

strengthen 

bones.
Bones are not what

 you think they are
When you think of bones, you might imagine a hard, brittle 

skeleton. In reality, your bones are living organs. They 

are alive with cells and fl owing body fl uids. Bones are 

constantly renewed and grow stronger with a good diet and physical activity. 

The amount of calcium that makes up your bones is the measure of how 

strong they are. But your muscles and nerves must also have calcium and 

phosphorus to work. If these are in short supply from foods you eat, 

your body simply takes them from your bones. 

Each day calcium is deposited 

and withdrawn from your bones. 

If you don’t get enough calcium, 

you could be withdrawing more 

than you’re depositing. That’s why 

children and teens need to build 

their bones early so they have 

a “savings account” of calcium 

for later. Our bodies build up 

calcium in our bones effi ciently 

until we are about 30 years old. 

Then our bodies stop adding new 

bone. But healthy habits can help 

us keep the bone we have.

7

Active

Growth

Slow

Loss

Rapid

Loss

Less

Rapid

Loss

10 20 30 40 50 60 70 80 90

Age in Years

Bone Growth/Loss

?

Do you spend 

your free 

evenings on 

the sofa or 

taking a walk? 

After your mid-30s, you 

begin to slowly lose bone 

mass. Women lose bone 

mass faster after menopause, 

but it happens to men too.

Less

Rapid

Loss

60 70

ears

40 50 70 80 90

ge in Years

10 20 60
When Bones Break

There is some natural bone loss as women and men age. As we grow 

older, bones can break or weaken if we don’t take steps to keep them 

strong. The most common breaks in weak bones are in the wrist, spine, 

and hip. 

Broken bones in your 

spine are painful and 

very slow to heal. 

People with weak bones 

in their spine gradually 

lose height and their 

posture becomes 

hunched over. Over 

time a bent spine can 

make it hard to walk or 

even sit up. 

Broken hips are a very 

serious problem as we age. 

They greatly increase the risk of 

death, especially during the year 

after they break. 

wrist

8

”

“

The most 

common 

breaks in 

weak bones 

are in the 

wrist, spine, 

and hip.

spine

hip
9

People who break a hip might not recover for months or even years. 

Because they often cannot care for themselves, they are more likely to 

have to live in a nursing home.

 

fastfact Hip fractures are by far the most devastating 

type of broken bone. They account for about 

300,000 hospitalizations every year.

Tips for keeping 

bones strong

● Calcium is found in foods like 

milk, leafy green vegetables, and 

soybeans. Enjoy snacks of yogurt 

and cheese to increase your 

calcium. You can also take calcium 

supplements or eat food specially 

fortifi ed with calcium. 

● Your body needs vitamin D to 

absorb calcium. Make sure you get 

enough vitamin D from your diet, 

sunshine, or supplements.

● Even simple activities like walking 

and stair climbing will strengthen 

your bones. Get at least 30 minutes 

of physical activity a day, even 

if it’s only 10 minutes at a time. 

(Children should get at least 

60 minutes a day.)

”

“

Get your 

bone 

density 

checked 

if you 

have any 

kind of a 

fracture 

after age 

50.
You could be at risk
Why being active makes

your bones strong

When you jump, run, or lift a weight, it puts stress on 

your bones. This sends a signal to your body that your 

bones need to be made stronger. New cells are added 

to strengthen your bones. If you are right-handed, the 

bones in your right arm are slightly larger and stronger 

from the extra use.

11

Too many of us assume we are not at risk for bone loss or 

fractures. We believe that if we haven’t had any signs of bone 

damage, then our bones are strong. Because there are no 

obvious warning signs, even doctors often miss signs of the problem. 

Most of us have our blood pressure and cholesterol checked for heart 

health. Testing bone density is the surest way to check for bone health.

The risk of osteoporosis is highest among women. It is also higher 

for Whites and Asians than other groups. However, it’s important to 

remember that it is a real risk for older men and women of all backgrounds.

That’s why it is important to know the risks for poor bone health at all 

ages. There are many “red fl ags” that are signs that you are at risk for weak 

bones. (See page 24 for a checklist.) In addition, your calcium and vitamin 

D intake, level of physical activity, and medications should all be evaluated.

Here are some 

clues that you 

are at risk:

Your older 

relatives have 

had fractures. 

You have had 

illnesses or 

have been on 

medications 

that might 

weaken bones.

You are 

underweight.
Bone Up On Your Diet

Calcium

To keep your bones strong, eat foods rich in calcium. Some people have 

trouble digesting the lactose found in milk and other dairy foods, including 

cheese and yogurt. Most 

supermarkets sell lactosereduced dairy foods. Many 

nondairy foods are also 

calcium-rich.

Vitamin D

Vitamin D helps your 

body absorb calcium. 

As you grow older, your need for vitamin D goes up. Vitamin D is made 

by your skin when you are in the sun. For many, especially seniors, getting 

enough vitamin D from sunshine is not practical. Almost all milk and 

some other foods are fortified with vitamin D. If you are not getting enough 

calcium and vitamin D in your diet, supplements can be bone savers.

12

Food labels, 

like this skim 

milk label, tell 

you how much 

calcium and 

vitamin D you 

get per serving.

If this is your age, then you need this much calcium

each day (mg).

0 to 6 months 210

7 to 12 months 270

1 to 3 years 500

4 to 8 years 800

9 to 18 years 1,300

19 to 50 years 1,000

Over 50 years 1,200

(A cup of milk or fortified orange juice has about 300 mg

of calcium.)

Your body needs calcium.

until age

50

You need more vitamin D as you get older.

200 IU

400 IU

600 IU

age

51-70

over age

70

Daily vitamin D needs

in International Units (IU)

Multivitamins typically provide

400 IU of vitamin D.

One cup of vitamin D

fortified milk or juice

MILK provides 100 IU.

Nutrition Facts

Serving Size 1 cup (236mL)

Servings Per Container 8

Amount Per Serving

Calories 90 Calories from Fat 0

Total Fat 0g

Saturated Fat 0g

Cholesterol 5mg

Sodium 125mg

Total Carbohydrate 13g

Dietary Fiber 0g

Sugars 12g

Protein 8g

% Daily Value*

0%

0%

2%

5%

4%

0%

Vitamin A Vitamin C 4%

Iron 0%

10%

Calcium 30%

Vitamin D 25%

* Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher

or lower depending on your calorie needs.

INGREDIENTS: MILK,

VITAMIN D3 ADDED.
fastfact Lack of calcium has been singled out as a 

major public health concern because it is 

critically important to bone health. The 

average American consumes far less than 

the amount recommended.

Calcium Calculator

Help your bones. Choose foods that are high in calcium. Here are some examples.

Your

total

today

Food Calcium (mg) Points

Fortified oatmeal, 1 packet 350 3

Sardines, canned in oil, with edible bones, 3 oz. 324 3

Cheddar cheese, 1 1/2 oz. shredded 306 3

Milk, nonfat, 1 cup 302 3

Milkshake, 1 cup 300 3

Yogurt, plain, low-fat, 1 cup 300 3

Soybeans, cooked, 1 cup 261 3

Tofu, firm, with calcium, 1/2 cup 204 2

Orange juice, fortified with calcium, 6 oz. 200-260 (varies) 2-3

Salmon, canned, with edible bones, 3 oz. 181 2

Pudding, instant, (chocolate, banana, etc.) made with 2% milk, 1/2 cup 153 2

Baked beans, 1 cup 142 1

Cottage cheese, 1% milk fat, 1 cup 138 1

Spaghetti, lasagna, 1 cup 125 1

Frozen yogurt, vanilla, soft-serve, 1/2 cup 103 1

Ready-to-eat cereal, fortified with calcium, 1 cup 100-1000 (varies) 1-10

Cheese pizza, 1 slice 100 1

Fortified waffles, 2 100 1

Turnip greens, boiled, 1/2 cup 99 1

Broccoli, raw, 1 cup 90 1

Ice cream, vanilla, 1/2 cup 85 1

Soy or rice milk, fortified with calcium, 1 cup 80-500 (varies) 1-5

Points Needed:

babies/toddlers (ages 0-3) need .........2-5

children (ages 4-8) need .............................8

teens need ......................................................13

adults under 50 need ................................10

adults over 50 need ...................................12
Protect your bones

 at every age
15

P

eople of all ages need to know what they can do to have strong 

bones. You are never too old or too young to improve your 

bone health. 

Babies

Bone growth starts before babies are born. Premature and low-birth-weight 

infants often need extra calcium, phosphorus, and protein to help them 

catch up on the nutrients they need for strong bones. Breastfed babies 

get the calcium and nutrients they need for good bone health from their 

mothers. That’s why mothers who breastfeed need extra vitamin D. Most 

baby formula contains calcium and vitamin D.

Children

Good bone health starts early in life with good habits. While children 

and young adults rarely get bone diseases, kids can develop habits that 

endanger their health and bones. Parents can help by encouraging kids 

to eat healthful food and get at least an hour of physical activity every 

day. Jumping rope, running, and sports are fun activities that are great 

for building strong bones. Children need the amount of calcium equal 

to 3 servings of low-fat milk each day. If your child doesn’t drink enough 

milk, try low-fat cheese, yogurt, or other foods that are high in calcium.

fastfact Children should get at least an hour of 

physical activity every day. Adults should get 

at least 30 minutes every day.

?

What if your 

toddler doesn’t 

like to drink 

milk? 

Include some 

low-fat cheese 

chunks or 

yogurt for 

snacks.

Make a cheesy 

sauce for 

vegetables or 

for a dip. 

Offer 

strawberry 

or chocolate 

milk as an 

afternoon 

treat.
Teens

Teens are especially at risk for not developing strong bones because their 

bones are growing so rapidly. Boys and girls from ages 9 to 18 need 

1,300 milligrams of calcium each day, more than any other age group. 

Parents can help teens by making sure they eat 4 servings of calcium-rich 

and vitamin-D-fortified foods a day. At least one hour a day of physical 

activities—like running, skateboarding, sports, and dance—is also critical. 

Studies show that only half of all teens exercise vigorously on a regular 

basis, and one-fourth do not exercise at all. But take note: extreme 

physical exercise, when combined with under-eating, can weaken teens’ 

bones. In young women this situation can lead to a damaging lack of 

menstrual periods. Teens who miss adding bone to their skeletons during 

these critical years never make it up. 

Adults

Adulthood is a time when we need to look carefully at our bone health. 

As adults, we need 1,000 to 1,200 milligrams of calcium, depending on 

our age, and at least 30 minutes of moderate physical activity every day. 

Activity that puts some stress on your bones is very important.

Physical activity at 

least 30 minutes 

every day

16

Your teen 

years are very 

important for 

strengthening 

bones through 

healthy eating 

and physical 

activity. 

Strength training 

2-3 times 

a week

Balance training 

once a week

Adults: keep your bones strong with physical activity.
?

17

fastfact Osteoporosis is a serious risk for any aging man 

or woman. Ten million people in the United 

States over the age of 50 have osteoporosis of 

the hip. About 4 in 10 women over 50 and 

1 in 10 men will break a hip, spine, or wrist.

Many women over 50 are at risk for bone disease, but few know it. 

At menopause, which usually happens in women over 50, a woman’s 

hormone production drops sharply. Because hormones help protect 

bones, menopause can lead to bone loss. Hormone therapy was widely 

used to prevent this loss, but now it is known to increase other risks. Your 

doctor can help advise you on protecting bone health around menopause.

Seniors

Seniors can take steps to help prevent bone problems. Physical activity 

and diet are vital to bone health in older adults. Calcium, together 

with vitamin D, helps reduce bone loss. Activities that put stress on 

bones keep them strong. Find time for activities like walking, dancing, 

and gardening. Strengthening your body helps prevent falls. Protecting 

yourself against falls is key to avoiding a broken hip or wrist. All women 

over 65 should have a bone density test.

Seniors should also know that recent studies conclude that anyone over 

age 50 should increase his or her vitamin D intake to 400 International 

Units (IU) per day. After age 70, 600 IU per day are needed. 

You are 

buying 

lunch. Do 

you choose 

milk or a soft 

drink?
You can prevent most falls.

Falls are not just the result of getting older. But as you age, 

falls become more dangerous. Most falls can be prevented. 

By changing some of the things listed here, you can lower 

the chances of falling for you or someone you love.

1. Begin a regular exercise program. 

Exercise is one of the most important ways to reduce 

your chances of falling. It makes you stronger and helps 

you feel better. Exercises that improve balance and 

coordination, like dancing and Tai Chi, are the most 

helpful. Consider joining an organized program at your 

local community center or gym.

2. Make your home safer.

● Remove things you can trip over from stairs and places 

where you walk. 

● Remove all small rugs. 

● Don’t use step stools. Keep items you need within easy 

reach. 

● Have grab bars put in next to your toilet and in the 

bathtub or shower. 

● Use non-slip mats in the bathtub and shower. 

● Use brighter light bulbs in your home. 

● Add handrails and light in all staircases. 

● Wear shoes that give good support and have non-slip 

soles. 

3. Ask a health care professional to review your 

medicines.

Ask your doctor, nurse, pharmacist, or other health care 

professional to review all the medicines you are taking. 

Make sure to mention over-the-counter medicine, such as 

cold medicine. As you get older, the way some medicines 

work in your body can change. Some medicines, or 

combinations of medicines, can make you drowsy or 

light-headed, which can lead to a fall.

4. Have your vision checked.

Poor vision increases your risk of falling. You could be 

wearing the wrong glasses or have a condition such as 

glaucoma or cataracts that limits your vision.

Falls Break Bones
19

Live Well, Live Strong, Live Long

It’s never too late or too early to improve your bone health. The average 

American eats too little calcium. And nearly half of us do not get enough 

physical activity to strengthen our bones. 

The same healthy lifestyle that strengthens your bones strengthens 

your whole body. You might not hear as much about bone health as 

other health concerns. But healthy habits are good for all your organs, 

including your bones.

● Be physically active every day—at least 60 minutes for children, 

30 minutes for adults. Do strength-building and weight-bearing 

activities to build strong bones.

● Eat a healthy diet. Educate yourself on proper nutrition. Be aware 

that certain foods are naturally rich in calcium and vitamin D. Get 

the recommended amounts of calcium and vitamin D daily.

● Reduce your risks of falling. Check your home for loose rugs, poor 

lighting, etc. Take classes that increase balance and strength—like 

Tai Chi or yoga. Make stretching a part of your workout.

Even people who know better don’t always do what’s good for their 

bones. Make yourself an exception. Be aware of your risks and work to 

reduce them. Get help from your family and friends and your doctor, 

nurse, pharmacist, or other health care professional. Building healthy 

bones begins at birth and lasts your whole life. 

”

“

Building 

healthy 

bones 

begins at 

birth and 

lasts your 

whole life.

fastfact A simple and enjoyable way to improve your 

balance is to take a class in dancing. Consider 

ballroom, western, salsa, or modern dance. 

Classes are offered by many community groups 

and adult education facilities.
Your doctor can help

 protect your bones
21

All women 

over 65 

should have 

a bone 

density test.

Talk to your doctor about bone health. Together you can 

evaluate your risks. Some things to discuss include your 

current health, your diet and physical activity levels, and your 

family background. 

Your doctor can look at your age, weight, height, and medical history. 

From that he or she can determine if you need a bone density test. 

Broken bones are a “red fl ag” for your doctor. If you break a bone after 

the age of 50, talk to your doctor about measuring your bone density. 

Even if you broke a bone in an accident, you might have weak bones. It 

is worth checking. 

Your doctor might recommend a medical test called a bone mineral 

density test. Bone density tests use x-rays or sound waves to measure how 

strong your bones are. These tests are quick (5 to 10 minutes), safe, and 

painless. They will give you and your doctor an idea of how healthy your 

bones are. All women over 65 should have a bone density test.

Your doctor might also want to do a blood test to check for a vitamin D 

defi ciency or abnormal calcium levels.
If your doctor finds that your bones are becoming weaker, there are 

things you can do to make them stronger. You can be more physically 

active, change your diet, and take calcium and vitamin D supplements. 

If your bones are already weak, there are medicines that stop bone loss. 

They can even build new bone and make it less likely that you will suffer 

a broken bone. 

Your doctor might suggest medications to help you build stronger bones. 

To reduce the chance that you might fall, have your vision checked.

When you speak to your doctor, be prepared with a list of questions and 

concerns. The list on the next page should help get you started.

See Your Doctor

While osteoporosis is the most common disease that harms bones, 

certain other conditions can also be harmful. Your doctor can help you 

learn if you are at risk and can help you treat these conditions. 

● Rickets and osteomalacia—Too little vitamin D causes these diseases in 

children and adults. They can lead to bone deformities and fractures.

● Kidney disease—Renal osteodystrophy can cause fractures.

● Paget’s disease of bone—Bones become deformed and weak, which can 

be caused by genetic and environmental factors. 

● Genetic abnormalities—Disorders like osteogenesis imperfecta cause 

bones to grow abnormally and break easily.

● Endocrine disorders—Overactive glands can cause bone disease. 

22

YES!

?

A 50-yearold woman 

breaks her 

wrist when 

she trips 

on a rug. 

Should she 

ask for a 

bone density 

test even if 

her doctor 

doesn’t 

bring it up?
What to discuss with your doctor

Talk with your doctor, nurse, or other health care professional 

about your bone health. Use this checklist to start your discussion.

■ Ask to check your risk for bone disease. 

■ Discuss your need for a bone density test.

■ Talk about any fall, even ones in which you were not hurt. 

Tell him or her about any broken bones you’ve had.

■ If you have fallen, ask about the need for a full evaluation. 

Tests include vision, balance, walking, muscle strength, heart 

function, and blood pressure. 

■ Go over all the medications you are taking (including overthe-counter ones). Do this at least once a year. This helps 

avoid dangerous drug interactions and taking higher doses of 

drugs than you need, which can lead to falls.

■ Ask if your doctor checks vision. Annual vision checks can 

help eliminate bone-breaking falls. 

■ Know your calcium and vitamin D intake. Report your totals 

to your doctor.

■ If you would like to try a new physical activity, ask about the 

best choices for you.

fastfact Bone disease is often a “silent” 

disorder until it causes a fracture.

23
Are you at risk for weak bones?

Check any of these that apply to you.

■ I’m older than 65.

■ I’ve broken a bone after age 50.

■ My close relative has osteoporosis or has broken a bone.

■ My health is “fair” or “poor.”

■ I smoke.

■ I am underweight for my height.

■ I started menopause before age 45.

■ I’ve never gotten enough calcium.

■ I have more than two drinks of alcohol several times a week.

■ I have poor vision, even with glasses.

■ I sometimes fall.

■ I’m not active.

■ I have one of these medical conditions:

 Hyperthyroidism

 Chronic lung disease

 Cancer

 Infl ammatory bowel disease 

 Chronic hepatic or renal disease

 Hyperparathyroidism

 Vitamin D defi ciency

 Cushing’s disease

 Multiple sclerosis

 Rheumatoid arthritis

■ I take one of these medicines:

 Oral glucocorticoids (steroids)

 Cancer treatments (radiation,

 chemotherapy)

 Thyroid medicine

 Antiepileptic medications

 Gonadal hormone suppression

 Immunosuppressive agents

If you have any of these “red fl ags,”

you could be at high risk for weak bones.

Talk to your doctor, nurse, pharmacist,

or other health care professional.

24
Acknowledgments

This public document was prepared by the U.S. Department of Health and Human Services 

under the direction of the Offi ce of the Surgeon General to make information in The 2004 

Surgeon General’s Report on Bone Health and Osteoporosis available in plain language to improve 

health literacy on this topic. Health literacy is the ability of an individual to access, understand, 

and use health-related information and services to make appropriate health decisions.

Richard H. Carmona, M.D., M.P.H., FACS, Surgeon General, U.S. Public Health Service, 

Offi ce of the Surgeon General, Offi ce of the Secretary, Washington, D.C.

Kenneth P. Moritsugu, M.D., M.P.H., Deputy Surgeon General, U.S. Public Health Service, 

Offi ce of the Surgeon General, Offi ce of the Secretary, Washington, D.C.

Editors

Joan A. McGowan, Ph.D., Senior Scientifi c Editor, Bone Health and Osteoporosis: A Surgeon 

General’s Report, Director, Musculoskeletal Diseases Branch, Extramural Program, National 

Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 

Bethesda, Maryland.

Lawrence G. Raisz, M.D., Scientifi c Editor, Bone Health and Osteoporosis: A Surgeon 

General’s Report, Board of Trustees Distinguished Professor of Medicine, Interim Director, 

Musculoskeletal Institute, Division of Endocrinology and Metabolism, University of 

Connecticut Health Center, Farmington, Connecticut.

Allan S. Noonan, M.D., M.P.H., CAPT, U.S. Public Health Service, Scientifi c Editor, 

Bone Health and Osteoporosis: A Surgeon General’s Report, Offi ce of the Surgeon General, 

Offi ce of the Secretary, Washington, D.C.

Ann L. Elderkin, P.A., Managing Editor and Project Director, Bone Health and Osteoporosis: 

A Surgeon General’s Report, Health Systems Research, Inc., Washington, D.C.

Advisors

Craig Stevens, M.A., Director of Communications, Offi ce of the Surgeon General, 

Offi ce of the Secretary, Washington, D.C.

Jennifer Cabe, M.A., Speechwriter, Offi ce of Public Health and Science, Offi ce of the Secretary, 

Washington, D.C.

Writing and Design Team

Pete Xiques, Writer, Science Applications International Corporation, Oak Ridge, Tennessee.

Vickie Reddick, Writer, Science Applications International Corporation, Oak Ridge, Tennessee.

C. Mark Van Hook, Graphic Designer, Science Applications International Corporation, 

Oak Ridge, Tennessee.

Priscilla Henson, Editorial Assistance, Science Applications International Corporation, 

Oak Ridge, Tennessee.
You are never too old or too young to

 improve your bone health.

For more information

For more information on your bone health, talk to your doctor, nurse, 

pharmacist, or other health care professional.

More information about the Surgeon General’s Report is available on the 

Surgeon General’s website at

www.surgeongeneral.gov 

More facts and advice are available from

National Institutes of Health Osteoporosis and Related Bone Diseases

~ National Resource Center

1232 22nd Street, NW

Washington, D.C. 20037-1292 

Phone: 202-223-0344

Toll Free: 800-624-2663

TTY: 202-466-4315

www.osteo.org

To order copies of 

this booklet or the full 

Surgeon General’s 

report, Bone Health 

and Osteoporosis: 

A Surgeon General’s 

Report, call toll free

1-866-718-BONE