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Discussant Susan L. Greenspan, MD

JAMA. 1999;281:1531-1540.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR DALEY: Mrs Z is a 73-year-old married grandmother who lives in a suburb of Boston, Mass, with her husband. She works 4 days per week in her daughter's retail business. Her gynecologist recently referred her for evaluation of "thin bones." Mrs Z has medical insurance through Medicare and supplemental insurance.

Mrs Z underwent menarche at age 11 years and had normal menstrual periods until menopause at age 50 years. She had 2 uncomplicated pregnancies and took oral contraceptives for many years. After menopause, she took hormone replacement therapy (HRT) for only 3 years, then stopped because of fear of developing breast cancer. She smoked for 1 year in her teens and quit; she does not drink alcohol. She has never taken glucocorticoids, anticonvulsants, or thyroid medication. Her mother fractured her hip twice. There is no family history of breast cancer. The patient's daily dietary . . . [Full Text of this Article]

MRS Z: HER UNDERSTANDING AND PERCEPTIONS

DR H, THE PATIENT'S GYNECOLOGIST: HER UNDERSTANDING AND PERCEPTIONS

AT THE CROSSROADS: QUESTIONS TO DR GREENSPAN

Risk Factors

Bone Mass Measurements

Secondary Causes of Bone Loss

General Preventive Measures

Prevention and Treatment of Osteoporosis

Treatment for Mrs Z

CONCLUSION

QUESTIONS AND DISCUSSION

Author Affiliation: Dr Greenspan is Director, Osteoporosis Prevention and Treatment Center, Director, Bone Density Testing Center, Program Director, Harvard-Thorndike General Clinical Research Center, Beth Israel Deaconess Medical Center, and Associate Professor of Medicine, Harvard Medical School, Boston, Mass.

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