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CMAJ
CMAJ - December 1, 1998JAMC - le 1 décembre 1998

Assessing osteoporosis risk

CMAJ 1998;159:1355

See response from: D. Kendler
In reply to a letter from a participant in the BC Study of Osteoporosis Risk1 [letter] David Kendler2 [letter] states that the review of bone mineral density testing prepared by the BC Office of Health Technology Assessment (BCOHTA) was never made public. In fact, the report (entitled Bone Mineral Density Testing: Does the Evidence Support its Selective Use in Well Women?) has been distributed widely to the public, to universities and to health sciences libraries and is available free of charge to any member of the public by contacting the BCOHTA (604 822-7049).

The BCOHTA report discusses the problems of risk assessment — limitations that neither Kendler's letter nor the BC Study of Osteoporosis Risk address. The review found that the available methods of measuring bone mineral density, including calcaneal ultrasonography, with and without risk assessment lead to misdiagnosis of well women more often than not. Kendler was one of several BC clinicians invited by the BCOHTA in January 1996 to inform our review. None of the local clinical proponents of bone mineral density technologies have been able to provide a substantive challenge to the scientific analysis of the limitations of these technologies laid out in the report.

Kendler implies that because of the BCOHTA report, hospital administrators withdrew support for the Study of Osteoporosis Risk. Although we would be pleased to take full credit for this decision, Kendler's clinical colleagues also deserve mention for their on-the-record criticism of the study.3

The truly tragic dimension of Kendler's study is demonstrated by the testimonial from Agnes Sovereign.1 This woman has been quadriplegic for the past 6 years and has suffered from multiple sclerosis for 16 years. She has been led to believe not only that the heel ultrasound test was necessary to determine that she had "seriously deficient" bone density, but also that this test result could somehow help clinicians to help her. Rather than lobbying to improve seriously underfunded services such as home care nursing and physiotherapy programs, Kendler has encouraged societies of people with cerebral palsy, multiple sclerosis, paraplegia and other disabilities to rally support for an unproven technology.

Carolyn Green, BHSc(PT), MSc
Research Associate
Ken Bassett, MD, PhD
Senior Medical Consultant
Arminee Kazanjian, DrSoc
Associate Director
BC Office of Health Technology Assessment
Centre for Health Services and Policy Research
University of British Columbia
Vancouver, BC

Disclosure: None declared

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References
  1. Sovereign A. Debating the management of osteoporosis risk [letter]. CMAJ 1998;158(5):586.
  2. Kendler D. Debating the management of osteoporosis risk [letter]. CMAJ 1998;158(5):586-7.
  3. Munro M. Unproven bone-scan tests cancelled. The Vancouver Sun 1997 Jan 9; Sect B:2c.