Changing perceptions in osteoporosis
Authors: C W McGrother, M M K Donaldson, D. J Torgerson, N. B Watts, P. D Miller, T. J Wilkin
Journal: BMJ (1999)

# Several risk factors are important {#article-title-2} EDITOR—Wilkin argues for broadening the indication for treatment of osteoporosis to “infirm older people.”1 There are several problems with the specific case he makes but evidence nevertheless to support a move in this direction. He deduces that frequency of impact is the main risk factor for fracture Falling is indeed a recognised risk factor, but the evidence suggests that it is just one among several predictors.2 Surprisingly, few researchers have attempted to combine their results to produce a risk score. We have identified one study that produced a score with a sensitivity of 70% and specificity of 98% on the basis of three factors—bone mineral density, body sway, and muscle strength.3 This prediction is for fractures occurring within a fairly short follow up time and probably overestimates the potential for effective intervention. Our preliminary results from a similar cohort provide support for a risk score approach over a longer period.4 We suggest that there is a case for focusing on elderly people but that the approach should be based on firm evidence and involve a specific risk score rather than a nebulous concept of infirmity. Hormone replacement therapy and bisphosphonates are costly and have important side effects and should not be used indiscriminately in any age group. a Competing interests: None declared. 1. 1.↵1. Wilkin TJ . Changing perceptions in osteoporosis [with commentary by R Eastell]. BMJ 1999; 318: 862–864. [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Eddy DM, 2. Johnston CC, 3. Cummings SR, 4. Dawson-Hughes B, 5. Lindsay R, 6. Melton LJ III., 7. et al . Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Osteoporosis Int 1998; suppl 4: S7–80. 3. 3.↵1. Nguyen T, 2. Sambrook P, 3. Kelly P, 4. Jones G, 5. Lord S, 6. Freund J, 7. et al . Prediction of osteoporotic fractures by postural instability and bone density. BMJ 1993; 307: 1111–1115. 4. 4.↵1. McGrother CW, 2. Donaldson MMK, 3. Clayton D, 4. Clarke M . Development of a risk score for fracture within an elderly population. Osteoporosis Int 1998; 8 (suppl 3): 27. # Replacing bone mineral density with bone turnover is not a solution {#article-title-7} EDITOR—Low bone mineral density is a disease surrogate; as Eastell points out in his commentary on Wilkin's article on osteoporosis, it is unfortunate that this particular surrogate has been given the status of a true diagnosis.1 But Wilkin's suggestion of replacing bone mineral density with another surrogate, bone turnover, is not a solution to the deficiencies of bone mineral density. An important use for a surrogate is to identify groups of high risk patients so that treatment is directed most economically at those … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DWilkin%26rft.auinit1%253DT.%2BJ%26rft.volume%253D318%26rft.issue%253D7187%26rft.spage%253D862%26rft.epage%253D865%26rft.atitle%253DChanging%2Bperceptions%2Bin%2Bosteoporosis%2B%2595%2BCommentary%253A%2BBone%2Bdensity%2Bcan%2Bbe%2Bused%2Bto%2Bassess%2Bfracture%2Brisk%26rft_id%253Dinfo%253Apmid%252F10092270%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=318/7187/862&atom=%2Fbmj%2F319%2F7221%2F1371.atom