phrey Ham

Perception of osteoporosis by Belgian women who work in a university hospital.

Abstract: Campaigns to increase ‘awareness’ of osteoporosis have been organized. The aim of this study was to assess how Belgian women who benefit from superior conditions favoring ‘awareness’ perceive osteoporosis as being an important disease. A survey sent to the private home of all the women working in a university hospital in Brussels (n= 1154). From a list of 13 diseases the women were asked to rank, by order of importance, the five which they found to be the most important for a woman of their age. They were also asked about visits to physicians, and screening procedures. The response rate was 55.4%. A high uptake of medical visits and screening procedures was reported: 89% of the women had seen a general practitioner or a gynecologist and 81.6% had undergone at least one gynecologic examination during the previous year. Three times more women had ever undergone mammography than a bone mineral density (BMD) measurement. Overall, 18.1% reported having had a BMD measurement in the past. In women over 50 years, 61% reported having had a BMD measurement and 92.7% having had a mammogram. Osteoporosis was ranked among the five most important diseases by 19.4% of women before the age of 50 years and by 39.3% after that age, far behind breast cancer (respectively 86.3% and 77.7%) and uterine cancer (respectively 74.2% and 58.0%). Thus even among a population of women who benefit from superior conditions for information and screening, the perception of osteoporosis remains low, as does the uptake of osteoporosis screening.

Factors influencing the prescription of hormone replacement therapy.

Objective To assess the effects of age, bone mineral density, risk of cardiovascular disease, and of breast cancer on the prevalence of hormone replacement therapy (HRT) prescriptions. Methods Seventeen charts of postmenopausal women were summarized. For each chart, we constructed 36 different cases by modifying the age (two levels), the bone mineral density (three levels), the cardiovascular risk (three levels), and the breast cancer risk (two levels). Twelve cases of these 612 files were sent to each Belgian gynecologist (n = 1010). Results Overall, HRT was prescribed in 67% of the cases. It was prescribed in 54.6% of women who had a normal bone mass, 67.9% of women with a low bone mass, and 79.0% of those with osteoporosis (P < .001). The prescription rate was higher in younger women (mean ± standard deviation 55 ± 4 years) than in their peers who were 10 years older (79.3% versus 55.2%; p < .001). No significant variation was observed in relation to the cardiovascular risk profile or to breast cancer risk. Conclusion Osteoporosis is associated with an increased rate and older age with a decreased rate of HRT prescription, whereas no difference is observed in association with cardiovascular or breast cancer risk.

Clinical significance of heterogeneity of vertebral mineral density

Important variations in Z-score per vertebra, which is a common expression of bone mineral density (BMD), are sometimes observed. The present study evaluates the clinical significance of this heterogeneity. Normal and osteoporotic subjects were defined by using strict criteria. For every scan, the minimal Z-score (the vertebra with the lowest Z-score) and the delta Z (highest Z-score--lowest Z-score) was calculated. Of the investigated subjects, 30% presented a delta Z > or = 1. No significant correlation could be found between delta Z and age, BMD, height and weight. There was no difference in delta Z between scans of good, average or poor quality. Osteoporotic subjects had significantly lowered BMD values, whether evaluated through Z-scores for the L2-L4 site (P < 0.001; t = 3.71) or by minimal Z-score (P < 0.001; t = 3.97). Reproducibility calculated for the L2-L4 site on phantoms as well as on patients was excellent (C.V. < 1%). When reproducibility was calculated on each vertebra in vitro or in vivo, an increase in variability was observed. These data show that marked heterogeneity in BMD per vertebra is not infrequent. In some subjects low BMD may be measured at certain vertebrae but not at the total site. Our data suggest that in those cases the lowest BMD should be considered. In follow-up studies however, the BMD should be calculated on the L2-L4 segment, since a loss of precision is observed when only one vertebra is measured.

Serum Levels of Dehydroepiandrosterone Sulfate in the Perimenopausea

Conflicting results have been reported on the relationships between menopause and adrenopause1p2 and between adrenopause and cardiovascular risk factors .3-5 Menopause is best characterized by a major decrease in estradiol (E2) of ovarian origin and adrenopause by a major decrease in dehydroepiandrosterone sulfate (DHEA-S) of adrenal origin. We established the anthropometric and biological profiles of perimenopausal women according to their serum levels of DHEA-S.

Time related bias in longitudinal studies using dual photon absorptiometry

Examining the bone mineral density (BMD’s) slope of patients regularly followed in our department, we observed recently that the group of patients who had their last BMD during the last 6 months of 1989, had a different slope than patients who had their last BMD during the following 6 months. In order to investigate if a small time-related bias of measurement, unsuspected by the former quality control investigations, could exist, we performed the following analyses. A regression equation between BMD and time was calculated and a slope was obtained for 95 women who had been followed for at least 3 yr and had had at least 3 BMD measurements during that time. The women were divided in 3 groups according to when the last BMD measurement had been performed (July–December 1989, January–June 1990 or July–December 1990). The slopes of the 3 groups of patients were compared. For each value of BMD of every patient, a predicted BMD (BMDp) was calculated using the regression equation and the relative difference (RD) between BMDp and BMD was calculated and analysed in relation to time. There was a significant difference (p<0.05) between the slopes of patients in relation to the time when the last BMD had been measured. Significant fluctuations (p<0.001) in RD were observed in relation to time. These RD variations suggested the existence of a time-related error. The presence of this error is also substantiated by the fact that a parallelism existed between the curve of the RD variations and the curve of the mean values of BMD of all patients referred to our department, calculated per period of 4 months. Although the fluctuation of the latter curve was not statistically significant. This study revealed that despite regular quality checkings, an unsuspected not random error may exist. The methodology described in this study can be used as a supplementary long-term quality assessment.