Sir, – Further to "Older women urged to protect bone health" (News, October 20t), I agree entirely with the need for GPs to have better access to DXA scans which are often only available privately. I also agree early diagnosis is extremely important to treat osteoporosis and hopefully prevent fragility fractures. The implication appears to suggest that DXA scanning is necessary for the diagnosis of osteoporosis. Many osteoporotic fractures occur in people with perfectly normal bone density. Osteoporosis not only involves the density of bone but also the quality of bone and this is not measured by DXA. In the majority of cases a diagnosis of osteoporosis and susceptibility to low-trauma fractures can be assessed without the need for DXA scanning, the results of which, when taken in isolation, can be misleading when someone has a normal result. International guidelines suggest using simple online questionnaires, particularly for use by GPs, but also the general public, which assesses the 10-year likelihood of a fracture and often can indicate whether there is osteoporosis or not and whether specific treatment is advised or not without ever going to a bone densitometry unit. These measures are supported by the World Health Organisation and are available free online. I run a public densitometry unit and many patients can be fully assessed and advised without DXA scanning, freeing up slots for the relative minority of osteoporotic patients who need a scan. – Yours, etc,
Dr MARK PHELAN,
Consultant Rheumatologist,
South Infirmary Victoria
University Hospital,
Cork.