Changing perceptions in osteoporosis

BMJ 1999;319:1371 ( 20 November )

Letters

Changing perceptions in osteoporosis

Several risk factors are important

Replacing bone mineral density with bone turnover is not a solution

Markers should be used as adjunct to bone densitometry

Author's reply

Several risk factors are important

The first 150 words of the full text of this article appear below.

EDITOR $---$ Wilkin argues for broadening the indication for treatment of osteoporosis to "infirm older people."¹ There are severalproblems with the specific case he makes but evidence neverthelessto support a move in this direction. He deduces that frequencyof impact is the main risk factor for fracture. Falling is indeeda recognised risk factor, but the evidence suggests that it isjust one among several predictors.²

Surprisingly, few researchers have attempted to combine their results to produce a risk score. We have identified one studythat produced a score with a sensitivity of 70% and specificityof 98% on the basis of three factors $---$ bone mineral density, bodysway, and muscle strength.³ This prediction is for fracturesoccurring within a fairly short follow up time and probably overestimatesthe potential for effective intervention. Our preliminary resultsfrom a similar cohort provide support for a risk score approachover . . . [Full text of this article]

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