Screening for Osteoporosis

Excerpt

To the Editors: The recent paper on screening for osteoporosis by Melton and colleagues (1) was an excellent review of the existing data. Their estimates of the effectiveness of screening are based on some assumptions that are reasonable but unproven, and I think two of these deserve further emphasis.

One assumption is that the 50% reduction in the lifetime risk for hip fracture is independent of the initial bone density. The retrospective, case-controlled studies that demonstrate this did not take bone mass into consideration. It is possible that the estrogen had the greatest effect in those women with bone density