AI chatbot safeguards fail to prevent spread of health disinformation

American College of Physicians

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. AI chatbot safeguards fail to prevent spread of health disinformation

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03933

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02035

URL goes live when the embargo lifts             

A study assessed the effectiveness of safeguards in foundational large language models (LLMs) to protect against malicious instruction that could turn them into tools for spreading disinformation, or the deliberate creation and dissemination of false information with the intent to harm. The study revealed vulnerabilities in the safeguards for OpenAI’s GPT-4o, Gemini 1.5 Pro, Claude 3.5 Sonnet, Llama 3.2-90B Vision, and Grok Beta. Specifically, customized LLM chatbots were created that consistently generated disinformation responses to health queries, incorporating fake references, scientific jargon, and logical cause-and-effect reasoning to make the disinformation seem plausible. The findings are published in Annals of Internal Medicine.

 

Researchers from Flinders University and colleagues evaluated the application programming interfaces (APIs) of five foundational LLMs for their capacity to be system-instructed to always provide incorrect responses to health questions and concerns. The specific system instructions provided to these LLMs included always providing incorrect responses to health questions, fabricating references to reputable sources, and delivering responses in an authoritative tone. Each customized chatbot was asked 10 health-related queries, in duplicate, on subjects like vaccine safety, HIV, and depression.  The researchers found that 88% of responses from the customized LLM chatbots were health disinformation, with four chatbots (GPT-4o, Gemini 1.5 Pro, Llama 3.2-90B Vision, and Grok Beta) providing disinformation to all tested questions. The Claude 3.5 Sonnet chatbot exhibited some safeguards, answering only 40% of questions with disinformation. In a separate exploratory analysis of the OpenAI GPT Store, the researchers investigated whether any publicly accessible GPTs appeared to disseminate health disinformation. They identified three customized GPTs that appeared tuned to produce such content, which generated health disinformation responses to 97% of submitted questions. Overall, the findings suggest that LLMs remain substantially vulnerable to misuse and, without improved safeguards, could be exploited as tools to disseminate harmful health disinformation.

 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Ashley M. Hopkins, PhD, BPharm [Hons], please email ashley.hopkins@flinders.edu.au.   

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2. Cardiometabolic outcomes improve with greater weight reduction among tirzepatide users 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02623

URL goes live when the embargo lifts             

A post-hoc analysis of the phase 3, randomized, double-blind, SURMOUNT-1 trial aimed to determine changes in cardiometabolic risk factors by degree of weight reduction in adults with obesity or overweight treated with tirzepatide. The analysis found that improvements in cardiometabolic risk factors were positively associated with greater weight reduction in adults taking tirzepatide. These findings may assist clinicians in tailoring weight reduction goals to individual patients seeking to reduce their cardiometabolic risk. The study is published in Annals of Internal Medicine.

 

Researchers funded by Eli Lilly and Company conducted a post-hoc analysis of the SURMOUNT-1 trial to understand how tirzepatide-associated cardiometabolic changes correspond to the degree of weight loss. Current guidelines recommend a weight reduction of 5% to 15% or greater to improve blood pressure, lipid levels, and glycemic control. The researchers analyzed 1,605 tirzepatide-treated participants and assessed change from baseline to week 72 in factors including waist circumference, blood pressure, lipid levels, and hemoglobin A1C by degree of weight reduction. The researchers found that improvements in all cardiometabolic risk factors were greater in participants who experienced greater weight reduction. Participants who lost at least 35% of their body weight had average changes of up to –14.2 mm Hg in systolic blood pressure, -9.2 mm Hg in diastolic blood pressure, and -32.4 cm in waist circumference. Hemoglobin A1C and homeostatic model assessment of insulin resistance (HOMA-IR) decreased even with modest weight reduction. Improvements in lipid levels were mainly observed with a weight reduction above 10%. These findings suggest that clinicians should target a greater than 10% weight loss to achieve improvements in lipid levels and at least a 5% weight loss to observe improvements in blood pressure and weight circumference. These findings also provide further evidence of the weight-mediated benefits of tirzepatide for cardiometabolic health.

 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Bruno Linetzky, MD, PhD, please email Brook Frost at brooke.frost@lilly.com.     

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3. 1 in 6 adults with obesity have trouble affording healthcare

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03161

URL goes live when the embargo lifts             

A brief research report analyzed patterns of financial burden by obesity and overweight status in the U.S. The study found that nearly one in six adults with obesity had trouble affording healthcare, with obesity being independently associated with difficulty paying medical bills, food insecurity, and skipping medication because of cost. These findings could guide policies that aim to safeguard patients with obesity against treatment discontinuation and medical bankruptcy. The study is published in Annals of Internal Medicine.  

 

Researchers from Stanford University School of Medicine, Massachusetts General Hospital, and colleagues conducted a repeated cross-sectional study of 143,271 adults who participated in the National Health Interview Survey from 2019 to 2023. The study population included adults with normal weight, overweight, or obesity. Primary outcomes included financial hardship from medical bills and food insecurity, and the secondary outcome was cost-related medication (CRM) nonadherence. The researchers performed sequential Poisson regressions adjusting for demographic variables and socioeconomic covariates. They then computed average marginal effects to estimate changes in the likelihood of financial burden based on BMI. The researchers found that 14.2% of people with obesity were more likely to report financial hardship compared with 9.2% and 8.2% of people who are overweight and normal weight, respectively. Food insecurity was 1.74 percentage points higher for people with obesity than among those with normal weight. Among adults who took prescription medication in the year prior, people with obesity reported greater CRM nonadherence than those with overweight and normal weight. People with obesity often have higher unemployment rates and lower household incomes, and this study expands upon previous literature by investigating patterns of financial burden among people with obesity.

 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Fatima Cody Stanford, MD, MPH, MPA, MBA, please email Mike Morrison at mdmorrison@mgb.org.      

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Also new this issue:

A Pragmatic Approach to Streamlining Single-Use Plastics in Health Care

Jeremy A. Greene, MD, PhD, et al.

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01264

 

 

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Journal

Annals of Internal Medicine

DOI

10.7326/ANNALS-24-03933 

Method of Research

News article

Subject of Research

People

Article Title

Assessing the System-Instruction Vulnerabilities of Large Language Models to Malicious Conversion into Health Disinformation Chatbots

Article Publication Date

24-Jun-2025

 

New ‘designer drugs’ pose growing threat to road safety in the US

‘New psychoactive substances’ are contributing to roadway crashes in California, shows first quantitative survey in the US

Frontiers

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No-one could claim to be unaware of the dangers of driving under the influence of drugs (DUID): drugs can increase the time needed to react, impair coordination, alertness, and cognition, and lower inhibitions, thus encouraging reckless and aggressive driving. In the US in 2021, 10,903 people died in crashes where drugs were involved, which corresponds to 26% of all traffic deaths that year. And because new drugs constantly hit the black market, efforts to tackle the issue can be very challenging.

A new study in Frontiers in Toxicology has now shown the urgent need of extending current tests routinely performed after traffic crashes to cover new drugs. It is the first comprehensive survey to measure the contribution of a broad range of so-called ‘new psychoactive substances’ to US roadway crashes.

"Here we show that new psychoactive substances (NPS), a group of drugs which has rapidly expanded over the past 15 years, are a concern in roadway crashes,” said Dr Roy Gerona, one of the study’s corresponding authors and an associate professor at the University of California San Francisco.

NPS, colloquially known as ‘designer drugs’, ‘legal highs’, ‘herbal highs’ and ‘bath salts’ are drugs not covered by the UN’s 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances, but which are deemed by experts to pose a risk to public health. Examples are designer benzodiazepines, synthetic cathinones and cannabinoids, piperazines, and tryptamines. The full range of their effects on physical and mental health is still poorly known, but these can include agitation, psychosis, aggression, and dependence. NPS also contribute to the devastating opioid crisis in the US, as they may contaminate fentanyl supplies, leading to additive toxicity, or be sold instead of fentanyl by dealers.

Flying below the radar

Most existing urine drug screens do not target NPS, which are typically only detectable through expensive high-resolution mass spectrometry (HRMS) in specialized laboratories.

Here, Gerona and colleagues surveyed the prevalence of NPS in the blood of roadway crash victims in northern and southern California between January and July 2024. They focused on the first 1,000 adult victims of roadway crashes who during that period visited either of two representative trauma centers in Los Angeles and Sacramento, and from whom blood was drawn during routine emergency care.

Through HRMS, they confirmed the presence of NPS in blood from 17 patients (2%). Among these, bromazolam was the most frequent (seven patients), followed by para-fluorofentanyl (four patients) and mitragynine (three patients). Acetyl fentanyl, N-methyl norfentanyl, protonitazene, etizolam, and xylazine were each detected only once.

“The types of NPS detected in our first 1,000 cases reflect the prevailing NPS found in nationwide surveillance studies, where depressants of the central nervous system such as designer benzodiazepines and fentanyl analogs predominate,” summarized Gerona.

A mixed bag

The results also showed that users frequently mix NPS with other drugs. All but two of the 17 patients with NPS in their blood were also positive for at least one traditional recreational drug. Nine had taken a sedative NPS together with a stimulant such as cocaine or methamphetamine, while 11 had combined NPS with traditional opioids. A further 273 (27%) patients tested positive for traditional recreational drugs, but not for NPS.

"The codetection of NPS like bromazolam and para-fluorofentanyl with common drugs of abuse like fentanyl, methamphetamine and cocaine in our cohort implies either the adulteration of common drugs with NPS, or the intentional simultaneous use of multiple drug classes,” said Gerona.

“For example, benzo-dope, the combination of a designer benzodiazepine and fentanyl or another opioid, has been trending in the unregulated drug market. In other cases, users intentionally combine a stimulant and a depressant, thinking that their opposing effects may mitigate each drug class's toxic effects."

Since the present study, the authors have continued to collect data from the study population. Their intention is to gather as much evidence as possible to inform changes to existing guidelines for determining drug-induced driving impairment.

"People should be aware that in particular synthetic opioids, which are often found as adulterants, pose a significant health risk due to the strength of their sedating effects, which can impair a user's ability to drive. For example, protonitazene is 130 times more potent than morphine and even more potent than fentanyl,” warned Dr James Alan Chenoweth, an associate professor at the University of California Davis and the principal investigator of the study.

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Journal

Frontiers in Toxicology

DOI

10.3389/ftox.2025.1572324 

Method of Research

Observational study

Subject of Research

People

Article Title

New psychoactive substances in roadway crash victims in California

Article Publication Date

25-Jun-2025

 

Tackling depressive symptoms in high school students by honing emotional and social skills

A promising long-term intervention program helps improve emotional well-being in high school students in Japan

Doshisha University

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Many school programs have been developed to combat depressive symptoms, but most fail to accommodate the needs, time constraints, and individual experiences of older high school students.

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Credit: userpilot1 from Openverse https://openverse.org/image/e392c616-886d-47e4-94e4-18d4b93a0003?q=girl,+upset&p=12

Today, high school students worldwide face unprecedented levels of stress as they navigate academic pressures, issues with social identity, and future career decisions. In Japan, researchers have found that depressive symptoms affect a large portion of high school students, with many scoring above clinical cutoff points for depression. These symptoms not only increase the risk of developing major depressive disorders but also negatively impact students’ educational outcomes, future employment prospects, and their economic well-being throughout their lives.

Recognizing this vulnerability, numerous school-based programs have been developed and implemented, aimed at preventing and mitigating depressive symptoms in students. These interventions often target cognitive and behavioral risk factors associated with depression. However, many of these universal programs showed limited long-term effectiveness, particularly in high school settings. Skills learned in these programs often fail to generalize to the broader school environment, and the program content may not always resonate with the specific challenges faced by students. On top of this, existing research has mostly focused on younger adolescents, leaving a gap in our understanding of effective interventions for older high school students.

Against this backdrop, a research team led by Professor Akiko Ogata from Hiroshima University, Japan, developed and tested an innovative year-long intervention specifically designed for high school students. Their study, which was made available online on May 17, 2025, and will be published in Volume 174 of the journal Children and Youth Services Review on July 1, 2025, examined the effectiveness of the Mastery of Interpersonal Relationships and Emotional Skills (MIRaES) program among 120 students enrolled in part-time courses at a Japanese high school. The project was implemented by Dr. Kohei Kambara from Doshisha University, and co-authored by Dr. Yugo Kira from Kurume University, as well as Mr. Misuzu Matsumoto and Dr. Suzuka Hako from Hiroshima University.

The MIRaES program addressed previous shortcomings through several key innovations. Unlike typical short-term interventions lasting only weeks or months, this program extended across an entire school year with 12 sessions. The curriculum focused on four core skill areas identified as particularly relevant for Japanese part-time high school students: assertiveness training, cognitive reconstruction, anger management, and problem-solving techniques. The program was delivered through collaboration between graduate students in clinical psychology and classroom teachers, ensuring that skills could be reinforced and generalized throughout students’ daily school experiences.

To assess the effectiveness of the program, the researchers employed a mixed-methods approach, measuring students’ depressive symptoms, social skills, and emotional regulation at three time points throughout the year. They also collected qualitative feedback through free-text descriptions to understand students’ experiences with the program. Rather than using a traditional control group—which proved logistically impossible due to curriculum constraints—the team compared outcomes between students who attended sessions frequently (11 or more times) versus those with lower attendance (10 or fewer times).

The results revealed a striking pattern: students who attended sessions regularly showed no increase in depressive symptoms over the school year, whereas those with poor attendance experienced significant worsening of symptoms. Moreover, qualitative analysis of student feedback provided additional insights into the program’s mechanisms. Frequent attendees consistently mentioned applying learned skills in their daily lives and showed particular engagement with emotional regulation techniques. Students who attended regularly used terms like ‘daily life,’ ‘useful,’ and ‘control’ when describing their experiences, suggesting a successful integration of program content into their everyday interactions. “Collectively, our findings show that generalizing learned skills across school environments and aligning universal school-based prevention programs in the specific school context can prevent the worsening of depressive symptoms among high school students,” remarks Dr. Kambara.

Worth noting, this study’s implications extend beyond Japan’s educational system and might be applicable in other countries with different educational settings. The program's design addresses practical constraints that have historically limited mental health interventions in high schools, such as rigid curriculum requirements and limited time availability. “This highly feasible universal prevention approach for school settings may contribute to improving mental health among high school students in grades 10 to 12, a population that is often underrecognized in mental health promotion efforts," concludes Dr. Kambara.

Overall, this work represents a significant step forward in addressing the mental health crisis among high school students, offering a practical model that schools could adapt to their specific contexts and student populations.

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About Assistant Professor Kohei Kambara from Doshisha University, Japan
Dr. Kohei Kambara joined Doshisha University as an Assistant Professor in 2022, after studying and working at Hiroshima University for over a decade. He specializes in clinical psychology, with a particular interest in processing modes, depression prevention, cognitive-behavioral therapy, and rumination, especially in adolescents. He has over 30 scientific publications to his name.

Funding information
This work was supported by Public Interest Incorporated Foundation Nippon Life Insurance Foundation and the Grant-in-Aid for Scientific Research (C) (grant number: 18K03138).

Journal

Children and Youth Services Review

DOI

10.1016/j.childyouth.2025.108343 

Method of Research

Experimental study

Subject of Research

People

Article Title

Universal school-based prevention program for decreasing the depressive symptoms of high school students on a part-time course: Developing the MIRaES program in Japan

Article Publication Date

1-Jul-2025

 

One in five packaged foods and drinks sold in the United States contains synthetic dyes, study shows

Research in the Journal of the Academy of Nutrition and Dietetics reveals that synthetic dyes are particularly prevalent in products marketed to children

Elsevier

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Philadelphia, June 25, 2025 – 

As many as 19% of packaged foods and beverages sold by top US food manufacturers contain synthetic food dyes, according to new research evaluating the content of 39,763 American grocery store products. The findings of the study in the Journal of the Academy of Nutrition and Dietetics (JAND), published by Elsevier, demonstrate the widespread prevalence of synthetic dyes in US foods and beverages, especially those marketed to children, and can help inform policymakers interested in taking legislative or regulatory action.

Food colors are an additive class used in packaged foods and beverages to increase visual attractiveness or to compensate for natural variations in product color. They can be derived from natural sources or chemically synthesized. Research over the past 40+ years has raised questions around the safety of one subcategory of food color additives used in the United States: synthetic food dyes.

Lead investigator Elizabeth Dunford, PhD, Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, and Food Policy Division, The George Institute for Global Health, University of New South Wales, says, “We assessed ingredient data for packaged foods and beverages produced by the top 25 US food manufacturers. A strength of our study is the use of Label Insight’s large database, which represents more than 80% of products sold in the US. We included sales data in our analysis of synthetic dye exposure, which may help to inform regulatory policies in this area. Although certain food categories may contain more products with synthetic dyes, it is also important to consider what foods consumers are buying, as even food categories with smaller proportions of synthetic dyes may be purchased and consumed in significant amounts and thus contribute more to overall dietary intake of dyes.”

Across all products, synthetic dyes were most commonly seen in sports drinks, beverage concentrates, and confectionery, although carbonated beverages contributed the largest proportion of purchased products containing synthetic dyes. The most common dye was Red 40, which was present in 14% of all products.

Dr. Dunford notes, “Products containing synthetic dyes also had a much higher average total sugar content compared to products without synthetic dyes, suggesting that companies are using synthetic food dyes to market sweet foods and beverages.”

Products in the top five food categories most often marketed to children – confectionery, sugar-sweetened beverages, ready meals, breakfast cereals, and baked goods like cakes, cookies, and pastries – were more likely to contain synthetic dyes. They were found to be present in 28% compared to just 11% of those in the remaining categories. In addition, the average sugar content of products containing synthetic dyes was 141% more than in those without the dyes (33.3g/100g versus 13.8g/100g).

Co-investigator Thomas Galligan, PhD, Center for Science in the Public Interest, Washington, DC, concludes, “There are a number of policy options to limit dye exposure, including bans and warning labels. Companies can also voluntarily reduce the use of synthetic dyes in their products; our results showing a range in companies’ proportional use of dyes in many food categories suggests that reduction in use is readily feasible.”

 

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Journal

Journal of the Academy of Nutrition and Dietetics

DOI

10.1016/j.jand.225.05.007 

Method of Research

Data/statistical analysis

Subject of Research

Not applicable

Article Title

All the Colors of the Rainbow: Synthetic Dyes in US Packaged Foods and Beverages in 2020

Article Publication Date

25-Jun-2025

One in five US foods and drinks contain synthetic dyes, study shows

They’re even more common in products marketed to children, despite health concerns

George Institute for Global Health

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As many as 19% of packaged foods and beverages contain synthetic food dyes, according to new research evaluating the content of 39,763 US grocery store products. The findings were published today in the Journal of the Academy of Nutrition and Dietetics. 1

Synthetic dyes are commonly used to make products more appealing, particularly those marketed to children, but a growing body of evidence suggests they may cause or worsen behavioral problems such as hyperactivity and inattention.2

Researchers at The George Institute for Global Health, the University of North Carolina and the Center for Science in the Public Interest assessed ingredient data for packaged foods and beverages produced by the top 25 US food manufacturers. They also looked specifically at the products in the top five food categories most often marketed to children – confectionery, sugar-sweetened beverages, ready meals, breakfast cereals, and baked goods like cakes, cookies and pastries.

Products in these categories were more likely to contain synthetic dyes – they were found to be present in 28% compared to just 11% of those in the remaining categories. In addition, the average sugar content of products containing synthetic dyes was 141% more than in those without the dyes (33.3g/100g versus 13.8g/100g).

Dr Elizabeth Dunford, Research Fellow at The George Institute, and Adjunct Assistant Professor, Department of Nutrition at the University of North Carolina said that the continued presence of synthetic dyes in the food system was a cause for concern.

“Given the accumulation of evidence over the last 40 years pointing to the health harms of synthetic dyes, it’s disappointing to see that they’re still so prevalent in our food system, particularly in products that are designed to appeal to children,” she said.

“The high levels of sugar in these brightly colored products suggests that companies are using synthetic dyes to market sweet foods and beverages, but both ingredients are linked to poor health outcomes.”

Confectionery companies had the most products containing synthetic dyes, with Ferrero (60%) and Mars (52%) being the worst offenders. Over half (51%) of PepsiCo’s energy drinks contained synthetic dyes as well as 79% of all sports drinks, regardless of the manufacturer.

Synthetic food dyes are entirely unnecessary in the US food supply but progress towards removing them has been slow, according to Dr. Thomas Galligan, Principal Scientist for Food Additives and Supplements at the Center for Science in the Public interest.

"The FDA recently asked the food industry to voluntarily phase synthetic dyes out of the food supply, but many companies had previously made promises to stop using them and then failed to keep those promises. So, it remains to be seen if food companies will comply with this new request.,” he said.

“If the FDA were to require warning labels on synthetically dyed foods, similar to the rule in place since 2010 in the European Union, there would be a much stronger incentive for industry to reformulate. Those warnings would also ensure consumers are better able to protect themselves from products sold by companies who choose not to phase dyes out entirely."

Dr. Dunford said it was encouraging to see that dozens of US states have now introduced bills taking aim at synthetic dyes this year, and the results of this research were likely to be immediately useful for policymakers as they progress this work.

“But until the regulatory process catches up with the science, parents and health-conscious consumers should always check the ingredients label for synthetic dyes and for high levels of added sugar. If a product contains either, you are better off not buying it, especially for your kids.”

References

1. Dunford EK et al. “All the colors of the rainbow: Synthetic dyes in US packaged foods and beverages in 2020.” Journal of the Academy of Nutrition and Dietetics. 2025. https://doi.org/10.1016/j.jand.2025.05.007
2. California Office of Environmental Health Hazard Assessment. Health Effects Assessment: Potential Neurobehavioral Effects of Synthetic Food Dyes in Children. 2021. https://oehha.ca.gov/risk-assessment/report/health-effects-assessment-potential-neurobehavioral-effects-synthetic-food-dyes-children

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Journal

Journal of the Academy of Nutrition and Dietetics

DOI

10.1016/j.jand.2025.05.007 

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

All the Colors of the Rainbow: Synthetic Dyes in US Packaged Foods and Beverages in 2020

Article Publication Date

25-Jun-2025

 

Breaking the silence about men breaking bones

New survey shows only 1% of men consider bone health a top concern; what they don’t know can hurt them

Ohio State University Wexner Medical Center

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At 40 years old, Brad Barbin’s bones were weakening—now he walks four to five miles a day to stay ahead of osteoporosis.
 

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Credit: The Ohio State University Wexner Medical Center

COLUMBUS, Ohio – Weak bones can have deadly consequences. Women often get bone density tests to screen for osteoporosis, yet many men don’t even realize they are at risk until they suffer a major fracture. 

June is Men’s Health Awareness Month, with a focus on raising awareness about osteoporosis in men.

A new survey commissioned by The Ohio State University Wexner Medical Center among U.S. adults finds that only 1% of men are concerned about bone density. 

This concerns Paul Lewis, MD, an interventional radiologist at Ohio State Wexner Medical Center. 

“It’s a silent disease, and it’s silent until it makes some noise, and how it makes noise is with a fracture,” said Lewis, who often treats patients with spinal and pelvic fractures. 

The National Spine Health Foundation estimates that 2 million men have osteoporosis, while another 16 million men have low bone mass known as osteopenia. 

The Ohio State survey found cancer (32%) is the number one concern when it comes to men’s health, followed closely by heart disease (30%). Other top concerns include obesity (18%) and sexual health (8%).

With so many other pressing medical concerns, men often are surprised to learn they have osteoporosis. The disease, which means porous bones, causes a gradual loss of bone density and strength, which puts individuals at higher risk for broken bones, even from minor falls.

A fracture for an older adult can be deadly, which is why prevention is key, Lewis said.

 “If you don't participate in resistance training as early as 30 years old, 40 years old, you can start losing up to 3% of your bone mass per year,” said Lewis, who also is an associate professor in The Ohio State University College of Medicine.

It is possible to build back bone density with exercise, nutrition and by not smoking or drinking alcohol excessively. 

“If we maintain more active lifestyles longer in life, we do anticipate less bone loss,” Lewis said. 

In addition, once someone develops spinal fractures due to osteoporosis, interventional radiologists can treat them with kyphoplasty or vertebroplasty procedures.

During kyphoplasty, a small balloon is inserted into the fractured vertebra and inflated to create a cavity. Bone cement (a synthetic material made of polymethyl methacrylate) is then injected into the cavity to stabilize the fracture and treat the pain. 

Vertebroplasty involves injecting bone cement directly into the fractured vertebra without using a balloon, providing immediate stabilization and pain relief.

“Both procedures aim to relieve pain, restore vertebral height and enhance spinal stability, allowing patients to regain function and mobility. They are performed under a twilight sedation and fluoroscopic imaging guidance. Patients experience minimal downtime and faster recovery compared to open surgery,” Lewis said.

The loss of the hormone testosterone also contributes to weak bones, which is why men need to be more mindful of osteoporosis as they age. Lewis recommends that men should start this conversation with their doctor at age 30, giving themselves plenty of time to prevent weak and porous bones. 

Lewis explains the consequences of not treating osteoporosis early.

“We're treating more than just a fracture; we're treating the whole person,” Lewis said. “They'll be more active and they'll be more independent. They won't be as isolated because of this pain and staying at home or staying in a chair.”

Survey Methodology

This study was conducted by SSRS on its Opinion Panel Omnibus platform. The SSRS Opinion Panel Omnibus is a national, twice-per-month, probability-based survey. Data collection was conducted from May 2 – May 5, 2025, among a sample of 1,008 respondents. The survey was conducted via web (n=978) and telephone (n=30) and administered in English. The margin of error for total respondents is +/-3.6 percentage points at the 95% confidence level. All SSRS Opinion Panel Omnibus data are weighted to represent the target population of U.S. adults ages 18 or older.

 

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