PREDICTION OF BONE LOSS RATE IN HEALTHY POSTMENOPAUSAL WOMEN

Prevention of fractures is the only way to drastically reduce osteopor osis-related health expenditures. In order to optimize the cost/benefi t ratio of a strategy of prevention, it is essential to identify, as e arly as possible, women who will develop fractures later in their life . Therefore, and since postmenopausal bone loss is an asymptomatic pro cess, screening procedures should detect, at the time of the menopause , women whose postmenopausal bone loss is higher than the mean, and wi ll, a couple of years later, exhibit a low mineral content and a subse quent high risk for fractures. For 3 years we have followed a cohort o f 92 healthy women who had undergone menopause less than 36 months pre viously. By a multivariate discriminant analysis based on the differen ces in lumbar bone density, assessed by dual photon absorptiometry, an d in a few routine biochemical parameters (serum phosphorus, estrone, androstenedione, and urine calcium) observed during the first 6 months of the study, we have been able to correctly predict the rate of spin al bone loss, observed at the end of the 3 years, in 76% of the subjec ts. All of the women who presented a bone loss higher than 10% over th e 3 years were correctly isolated by our discriminant functions after 6 months of follow-up. We conclude that a measurement of lumbar bone m ineral density coupled with a few routine biochemical determinations, repeated twice at a 6-month interval in healthy postmenopausal women, can isolate 100% of postmenopausal ''fast bone losers'' with an overal l specificity of 76%.