Roughly 10 million Americans over age 50 have osteoporosis, and another 34 million have low bone mass which puts them at risk for osteoporosis, fractures and related complications later in life, according to the National Osteoporosis Foundation. By 2020, those numbers are expected to rise to about 14 million individuals over 50 with osteoporosis and another 47 million with low bone mass, and the number of hip fractures in the United States could double or triple. Today, even with such a widespread problem, 70 percent of the nation's women with osteoporosis go undiagnosed and untreated. "It's due to a lack of knowledge and awareness among the public and healthcare professionals," said Dr. David Gams, an ob/gyn at Brookwood Medical Center. "It's a huge problem, because 30 million women in the U.S. are at risk, along with 13 million men." The surgeon general's report, "Bone Health and Osteoporosis," said studies have found low usage rates for testing and treatment among the high-risk population, including bone mineral density testing, calcium and vitamin D supplementation and antiresorptive therapy. "Most physicians do not discuss osteoporosis with patients even after a fracture," the report states. "Even when physicians do suggest therapy, it often does not conform to evidence-based recommendations." By identifying at-risk individuals and beginning appropriate interventions early, many cases of severe osteoporosis could be avoided. Assessment of calcium and vitamin D intake, physical activity and adverse behaviors should be a routine part of healthcare for all individuals. "We need more early intervention by physicians," said Beth Kitchin, UAB assistant professor of nutrition sciences and a registered dietician. "Red flags include a slender frame, smoking, family history, eating disorders and amenorrhea. These patients need to be tested and referred to a registered dietician if a problem is detected." Gams added that Caucasian women are generally more susceptible to osteoporosis, but physicians should screen at-risk minority patients as well. The surgeon general recommends bone mineral testing for any patient with a strong potential for osteoporosis. Other screening tools include an inexpensive heel scan and a DEXA scan, Gams said, but he added that one of the easiest tests to perform is a blood test to check a patient's vitamin D level. "A fundamental cause of low bone density is a lack of vitamin D consumption," Gams said. "Vitamin D levels should stay above 30." Kitchin added that vitamin D is important because calcium, which is necessary for bone building, cannot be absorbed by the body without vitamin D. A basic multivitamin and a calcium supplement with vitamin D should be sufficient, she said, but make sure the supplement contains vitamin D3 (cholecalciferol), not vtamin D2 (ergocalciferol). Once osteoporosis or osteopena is diagnosed, a number of therapies are available. Gams said a new monthly injection has been approved by the FDA for those who can't tolerate the oral medicines, giving patients another treatment option. Most doctors prescribe oral bisphosphonates such as Fosamax®, Actonel® and Boniva®, which are antiresorptive agents that keep the body from taking calcium from the bones. "Physicians need to explain that the patient still needs calcium," Kitchin said. "It's a misconception for patients – they think these medicines are high-powered calcium. I use the analogy that biphosphonate is the brick layer and calcium is the mortar." Patients should be encouraged to adopt a lifestyle that includes proper nutrition and regular physical activity. Such a lifestyle can not only help prevent osteoporosis but will improve an individual's overall health as well.