OSTEOPOROSIS IN A LARGELY SELF-REFERRED POPULATION - HIGH PREVALENCE BUT LOW MEDICAL PRIORITY - WHY

Dual photon bone density screening for osteoporosis (OF) and osteopeni a of the lumbar spine was performed in 108 women aged 34-75 years of w hom 91% were self-referred in a cross-sectional study. OP was present in 18.6% when defined as greater than 2 SD bone mineral density (BMD) reduction compared to young normals and in 41.6% with osteopenia (1 SD BMD reduction). Twelve percent gave an actual history of previous fra ctures. In those who showed reduced BMD (60%), 69.5% had a family hist ory and 54% scalp hair loss although this was not a good prognostic si gn. An Osteoporosis Risk Questionnaire was not an accurate predictor o f BMD, thus bone density screening remains essential for early and acc urate diagnosis. Previous oral contraceptive use appears to be protect ive (p = 0.004). Sex hormone replacement therapy (sHRT) taken by 20% o f the postmenopausal patients had not yet provided significant protect ion (p = 0.15) probably due to its late introduction, short exposure a nd failure to optimise dose levels. Despite detailed information and q uestionnaires provided to their doctors, of 53 patients with OP or ost eopenia 15 (28%) started sHRT without additional investigation, 19 (36 %) remained untreated, while the outcome in the rest, 19 (36%), was un known. A disturbing indifference by doctors and patients continues to the prevention and treatment of OP and low BMD, a potentially preventa ble and reversible condition, which signals a higher risk of future fr agility fracture.