Osteoporosis in a largely self-referred population: high prevalence but low medical priority: why?

Dual photon bone density screening for osteoporosis (OP) and osteopenia of the lumbar spine was performed in 108 women aged 34-75 years of whom 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 fractures. In those who showed reduced BMD (60%), 69.5% had a family history and 54% scalp hair loss although this was not a good prognostic sign. An Osteoporosis Risk Questionnaire was not an accurate predictor of BMD, thus bone density screening remains essential for early and accurate diagnosis. Previous oral contraceptive use appears to be protective (p = 0.004). Sex hormone replacement therapy (sHRT) taken by 20% of the postmenopausal patients had not yet provided significant protection (p = 0.15) probably due to its late introduction, short exposure and failure to optimise dose levels. Despite detailed information and questionnaires provided to their doctors, of 53 patients with OP or osteopenia 15 (28%) started sHRT without additional investigation, 19 (36%) remained untreated, while the outcome in the rest, 19 (36%), was unknown. A disturbing indifference by doctors and patients continues to the prevention and treatment of OP and low BMD, a potentially preventable and reversible condition, which signals a higher risk of future fragility fracture.