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I read with interest your article (News, July 23) highlighting the need for greater attention to be paid to osteoporosis, which echoes the editorial in the BMJ (July 16).

It is recognised that axial DEXA is the gold standard for assessment of osteoporosis. However, the National Osteoporosis Society in its report for the Department of Health exposes the fact that we need 126 additional scanners in England. We currently have 206, some of which may date back to 1990.

Large segments of the population at risk of osteoporosis and fracture have not been evaluated1. The National Osteoporosis Risk Assessment from the US found that peripheral bone mineral density results were highly predictive of fracture risk. Given the economic and social costs of osteoporosis, screening in the primary care setting needs to be established and implemented2.

To this end GPs with a special interest in osteoporosis would be well placed to achieve this, especially if osteoporosis was included in the quality outcomes framework of the contract.

Dr A Cooper

Crawley

West Sussex

1 de-Lusignan S et al. Can patients with osteoporosis, who should benefit from implementation of the NSF for older people, be identified from GP computer records? Public Health Nov 2003. vol 117 no6 p438-45

2 Siris ES et al. Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women. Results from the National Osteoporosis Risk Assessment. JAMA Dec 12 2001.

Vol 286, No 22: 2815-22

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