Women over 75 with fragility fractures should have DEXA

doi:10.1136/bmj.b2340

Published 9 June 2009, doi:10.1136/bmj.b2340
Cite this as: BMJ 2009;338:b2340

Letters

NICE on osteoporosis

Women over 75 with fragility fractures should have DEXA

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

The recent NICE guidance on osteoporosis has generated muchcontroversy and the publication of "alternative" guidelines.¹An aspect which has escaped attention is the advice that bonedensity scanning by dual energy x ray absorptiometry (DEXA)may not be required in women aged $≥$ 75 who have had a fragilityfracture. This has been incorporated into the osteoporosis directenhanced service agreement for general practitioners, whichadvises that these patients should be offered preventive treatmentwith bone sparing drugs without further investigation.

This advice is presumably based on the assumption that mostwomen aged $≥$ 75 with fragility fractures have osteoporosis. Wereviewed the results of DEXA in women aged $≥$ 75 with fragilityfractures who were evaluated by the Lothian and Glasgow fractureliaison services in 2007. The table shows that only half ofthem had osteoporosis.

View this table:

Prevalence of osteoporosis, osteopenia, and normal bone mineral density by service. Values are numbers (percentages)

. . . [Full text of this article]

Stuart H Ralston, ARC professor of rheumatology¹, Gina de’Lara, osteoporosis specialist nurse¹, Donald J Farquhar, consultant geriatrician², Stephen J Gallacher, consultant physician³, Jim Hannan, consultant medical physicist¹, Alastair R McLellan, consultant endocrinologist⁴

¹ Western General Hospital, Edinburgh EH4 2XU, ² St John’s Hospital, Livingston EH54 6PP, ³ Southern General Hospital, Glasgow G51 4TF, ⁴ Western Infirmary, Glasgow G11 6NT

Stuart.Ralston@ed.ac.uk