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P37. Osteoporosis, HRT and the menopause; attitudes and experience of perimenopausal women attending for bone density screening
Abstracts from the Joint Meeting,
September
1992
patients with frankly psychotic disturbances, leading to suicide or murder have been reported. We have applied a standardised psychiatric interview to 44 patients with primary hyperparathyroidism before and approximately three months after successful parathyroidectomy. The overall score improved significantly after surgery (p < 0.001) with the Wilcoxon signed rank test). Seven patients showed deterioration; in six of these this was associated with adverse life events or with pre-existing psychiatric illness. Before surgery the most common psychiatric abnormalities were fatigue, sleep disturbance, lack concentration, irritability and depression. These symptoms improved significantly after parathyroidectomy. Anxiety and intellectual impairment were also common but did not improve significantly, In the assessment of apparently mild hyperparathyroidism, questions should be directed at the symptoms in which improvement can be anticipated.
P35. Prevalence of vertebral deformities in Sheffield, UK NFA Peel, NA Barrington, R Eastell Department of Human Metabolism nnd Clinical Biochemistry, Department of Diagnostic Imaging, University of Sheffield Medical School, Sheffield The prevalence of vertebral fractures in the United Kingdom is not weU established. The aims of this study were: 1) to determine the prevalence of vertebral deformity in a population-based group of women using the same morphometric criteria as used by one of us in a previous study in a US population (EastelI et al, JBMR, 1991;207); 2) to determine whether vertebral deformities are associated with low bone mineral density (BMD). We studied 375 women (ages 50 to 85) randomly selected from general practices in Sheffield. Each subject had antero-posterior and lateral thoracic and lumbar spine radiographs. BMD of the lumbar spine, femoral neck, and total body were measured by DXA (Lunar DPX). 15 women (4%) had vertebral deformit& Vertebral deformity rate (W) Age UK USA Difference (95% CI) -2.6 (-6.5 to 3.3) <60 1.5 4.1 17.6 -13.0 (-24.2 to -2. 1) 60-69 4.6 16.3 -11.1 (-22.6 to -0.3) 70-79 5.2 >80 11.5 45.7 -34.2 (-53.0 to -15.2) BMD was decreased in the subjects with fractures after correcting for age and weight at the lumbar spine (Z-score = -0.63, P&05), total body (Z-score =-0.62, I’ < 0.05), but not the femoral neck (Zscore = -0.28, NS). We conclude that: 1) vertebral deformity prevalence rate in Sheffield is much lower than that in Ohnsted County, USA; 2) deformity resulting from fracture is associated with decreased mean BMD.
P36. Diet, activity and bone mass in post-menopausal women S Suleiman, C Moniz*, M Buxton-Thomas**, M Nelson Dept. of Nutrition 6 Dietitics, Kings College-London and ‘Clinical Biochemistry and “Nuclear Medicine, Kings College Hospital, London SE.5 To investigate the hypothesis that post-menopausal women with initial low calcium intake and low physical activity will benefit from a synergism between a combined regimen of calcium supplementation and weight bearing exercise in maintaining bone mass, 1000 women were sent questionnaires and there was a 45% response. After screening for several factors, 125 were eligible for screening for low calcium intake (1) and low physical activity (2). Sixty, found to be low on both criteria, will enter a study to look at the impact of low dietary calcium and physical activity on Bone Mineral Density (BMD) and Bone Turnover( Currently 25 women, mean age was 57.1(3)yrs menopausal age 8.2c2.4) have completed baseline measurements. BMD spine L2-L4 was 0.932(0.147) gm/cm? and trochanter 0.664 (0.098) gm/cm2. Calcium intake was 445(130)g/day and physical activity assessment was
125
37(13)hrs/week. Systemic markers of bone metabolism did not explain low hip BMD but will be used in conjunction with bone densitometry to examine the impact of calcium and weight bearing intervention therapy. 1. Nelson M.et al. J Human Nutr & Diet 1988;1:101-114. 2. Suleiman S., Nelson M. Validation of physical activity questionnaire (publication in preparation).
P37. Osteoporosis, HRT and experience of perimcnopausal density screening
the menopause; attitudes and women attending for bone
MJ Carton, EC Rennie’, DJ Torgerson** and DM Reid Department of Rheumatology, and *Osteoporosis screening unit, City Hospital, Urquhnrr Road, Aberdeen AB9 8AU, and “Health Economics Research Unit, Pofwnrth Building, University of Aberdeen, Foresterhill AB9 2ZB Long term compliance with hormone replacement therapy (HRT) has been reported to be poor, which has implications for population based strategies to prevent osteoporosis. It has been suggested that compliance may be improved if therapy is targeted at those who are ‘at risk’ of specific postmenopausal complications such as osteoporosis. We report the results of interviews with 200 consecutive women aged 45-49 years (71% pre-, 15% postmenopausal, 15% uncertain) randomly invited to attend for dual energy X-ray absorptiometry scans of the hip and Ap spine. Most women already knew about osteoporosis (81%) and HRT (94%) before attending the unit, usually from women’s magazines and TV. 85% of premenopausal women reported at least one menopausal symptom (46% had four or more symptoms), compared to 100% (90%) for postmenopausal women. 15% of premenopausal women were current or previous users of HRT, while among-postmenopausal women 13% had used HRT previously, and 37% were current users. Those who had never used HRT tended not to have discussed it with their GP, and many expressed concerns about side-effects, especially breast cancer; accordingly o.dy a minority (22%) definitely wanted HRT at the menopause. Two-thirds had never considered HRT to prevent osteoporosis before attending for a bone scan, but most (95%) said they would consider HRT for as long as their doctor recommended it (81%) if their bone scan showed they were at greater risk of future fracture. In conclusion, perimenopausal women experience considerable morbidity, and long term compliance may be favourably influenced by detecting and informing those at greatest risk of osteoporosis.
P38. The cost-effectiveness of appointment systems for screening service for low bone mineral density DJ Torgerson, MJ Garton*, C Donaldson, IT Russell” and DM Reid* Health Economics Research Unit, University of Aberdeen, Polwnrth Building, Foresterhill, Aberdeen, AB9 2ZD, ‘Department of Rheumatology, City Hospital, Aberdeen, AB9 8AU, ** Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB9 2ZD The cost-effectiveness of screening for low bone mineral density may be affected by the appointment method used. Two types of appointment methods are commonly used for screening services: firstly, a fixed appointment method which contains a time and date for attendance at the screening service; secondly, an open invitation method which requires the recipient to contact the screening service and make an appointment. The fixed appointment system often means reserved appointment slots are not used. The open invitation system utilises most of the reserved screening services; however compliance is significantly reduced with this method. We have developed a new appointment system which combines high attendance with high compliance. The new appointment method consists
September
1992
patients with frankly psychotic disturbances, leading to suicide or murder have been reported. We have applied a standardised psychiatric interview to 44 patients with primary hyperparathyroidism before and approximately three months after successful parathyroidectomy. The overall score improved significantly after surgery (p < 0.001) with the Wilcoxon signed rank test). Seven patients showed deterioration; in six of these this was associated with adverse life events or with pre-existing psychiatric illness. Before surgery the most common psychiatric abnormalities were fatigue, sleep disturbance, lack concentration, irritability and depression. These symptoms improved significantly after parathyroidectomy. Anxiety and intellectual impairment were also common but did not improve significantly, In the assessment of apparently mild hyperparathyroidism, questions should be directed at the symptoms in which improvement can be anticipated.
P35. Prevalence of vertebral deformities in Sheffield, UK NFA Peel, NA Barrington, R Eastell Department of Human Metabolism nnd Clinical Biochemistry, Department of Diagnostic Imaging, University of Sheffield Medical School, Sheffield The prevalence of vertebral fractures in the United Kingdom is not weU established. The aims of this study were: 1) to determine the prevalence of vertebral deformity in a population-based group of women using the same morphometric criteria as used by one of us in a previous study in a US population (EastelI et al, JBMR, 1991;207); 2) to determine whether vertebral deformities are associated with low bone mineral density (BMD). We studied 375 women (ages 50 to 85) randomly selected from general practices in Sheffield. Each subject had antero-posterior and lateral thoracic and lumbar spine radiographs. BMD of the lumbar spine, femoral neck, and total body were measured by DXA (Lunar DPX). 15 women (4%) had vertebral deformit& Vertebral deformity rate (W) Age UK USA Difference (95% CI) -2.6 (-6.5 to 3.3) <60 1.5 4.1 17.6 -13.0 (-24.2 to -2. 1) 60-69 4.6 16.3 -11.1 (-22.6 to -0.3) 70-79 5.2 >80 11.5 45.7 -34.2 (-53.0 to -15.2) BMD was decreased in the subjects with fractures after correcting for age and weight at the lumbar spine (Z-score = -0.63, P&05), total body (Z-score =-0.62, I’ < 0.05), but not the femoral neck (Zscore = -0.28, NS). We conclude that: 1) vertebral deformity prevalence rate in Sheffield is much lower than that in Ohnsted County, USA; 2) deformity resulting from fracture is associated with decreased mean BMD.
P36. Diet, activity and bone mass in post-menopausal women S Suleiman, C Moniz*, M Buxton-Thomas**, M Nelson Dept. of Nutrition 6 Dietitics, Kings College-London and ‘Clinical Biochemistry and “Nuclear Medicine, Kings College Hospital, London SE.5 To investigate the hypothesis that post-menopausal women with initial low calcium intake and low physical activity will benefit from a synergism between a combined regimen of calcium supplementation and weight bearing exercise in maintaining bone mass, 1000 women were sent questionnaires and there was a 45% response. After screening for several factors, 125 were eligible for screening for low calcium intake (1) and low physical activity (2). Sixty, found to be low on both criteria, will enter a study to look at the impact of low dietary calcium and physical activity on Bone Mineral Density (BMD) and Bone Turnover( Currently 25 women, mean age was 57.1(3)yrs menopausal age 8.2c2.4) have completed baseline measurements. BMD spine L2-L4 was 0.932(0.147) gm/cm? and trochanter 0.664 (0.098) gm/cm2. Calcium intake was 445(130)g/day and physical activity assessment was
125
37(13)hrs/week. Systemic markers of bone metabolism did not explain low hip BMD but will be used in conjunction with bone densitometry to examine the impact of calcium and weight bearing intervention therapy. 1. Nelson M.et al. J Human Nutr & Diet 1988;1:101-114. 2. Suleiman S., Nelson M. Validation of physical activity questionnaire (publication in preparation).
P37. Osteoporosis, HRT and experience of perimcnopausal density screening
the menopause; attitudes and women attending for bone
MJ Carton, EC Rennie’, DJ Torgerson** and DM Reid Department of Rheumatology, and *Osteoporosis screening unit, City Hospital, Urquhnrr Road, Aberdeen AB9 8AU, and “Health Economics Research Unit, Pofwnrth Building, University of Aberdeen, Foresterhill AB9 2ZB Long term compliance with hormone replacement therapy (HRT) has been reported to be poor, which has implications for population based strategies to prevent osteoporosis. It has been suggested that compliance may be improved if therapy is targeted at those who are ‘at risk’ of specific postmenopausal complications such as osteoporosis. We report the results of interviews with 200 consecutive women aged 45-49 years (71% pre-, 15% postmenopausal, 15% uncertain) randomly invited to attend for dual energy X-ray absorptiometry scans of the hip and Ap spine. Most women already knew about osteoporosis (81%) and HRT (94%) before attending the unit, usually from women’s magazines and TV. 85% of premenopausal women reported at least one menopausal symptom (46% had four or more symptoms), compared to 100% (90%) for postmenopausal women. 15% of premenopausal women were current or previous users of HRT, while among-postmenopausal women 13% had used HRT previously, and 37% were current users. Those who had never used HRT tended not to have discussed it with their GP, and many expressed concerns about side-effects, especially breast cancer; accordingly o.dy a minority (22%) definitely wanted HRT at the menopause. Two-thirds had never considered HRT to prevent osteoporosis before attending for a bone scan, but most (95%) said they would consider HRT for as long as their doctor recommended it (81%) if their bone scan showed they were at greater risk of future fracture. In conclusion, perimenopausal women experience considerable morbidity, and long term compliance may be favourably influenced by detecting and informing those at greatest risk of osteoporosis.
P38. The cost-effectiveness of appointment systems for screening service for low bone mineral density DJ Torgerson, MJ Garton*, C Donaldson, IT Russell” and DM Reid* Health Economics Research Unit, University of Aberdeen, Polwnrth Building, Foresterhill, Aberdeen, AB9 2ZD, ‘Department of Rheumatology, City Hospital, Aberdeen, AB9 8AU, ** Health Services Research Unit, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB9 2ZD The cost-effectiveness of screening for low bone mineral density may be affected by the appointment method used. Two types of appointment methods are commonly used for screening services: firstly, a fixed appointment method which contains a time and date for attendance at the screening service; secondly, an open invitation method which requires the recipient to contact the screening service and make an appointment. The fixed appointment system often means reserved appointment slots are not used. The open invitation system utilises most of the reserved screening services; however compliance is significantly reduced with this method. We have developed a new appointment system which combines high attendance with high compliance. The new appointment method consists