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To the Editor: In her excellent review of osteoporosis, Dr Greenspan¹ might have made more comment about Mrs Z's history of multiple fractures prior to her first bone density and "formal" diagnosis of osteoporosis. A guide entitled Physician's Guide to Prevention and Treatment of Osteoporosis, which was published by the National Osteoporosis Foundation,² lists 4 risk factors for hip fracture that are independent of bone density: personal history of fracture as an adult, history of fracture in a first-degree relative, current cigarette smoking, and low body weight (<57 kg).

The diagnosis of osteoporosis in Mrs Z should have been considered at the time of her wrist or elbow fractures. By that time she already had 2 of the 4 listed bone mineral density–independent risk factors (personal and family history of fracture) and it is most likely that her subsequent hip and spine fractures would have been avoided by proper intervention.

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RELATED ARTICLE

A 73-Year-Old Woman With Osteoporosis
Susan L. Greenspan
JAMA. 1999;281(16):1531-1540.
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