| Popis: |
The purpose of this chapter is to explain the pivotal role that BMD measurement has in the management of patients with osteoporosis. This relates not only to the management of patients in the community under the care of their general practitioner, but also patients referred from within the hospital setting from specialties such as orthopaedics, endocrinology and gynaecology. It is obviously important to encourage good working relationships with public health physicians working in Health Authorities or with relevant physicians within commissioning groups. This is particularly so since the use of bone densitometry in the management of osteoporosis had become an emotive topic in the UK following the publication of the Effective, Health Care Bulletin report in 1992. This is no longer the case following the Advisory Group on Osteoporosis report (AGO) with its recommendation that the Department of Health should develop guidelines on the prevention and treatment of osteoporosis. Subsequently The Royal College of Physicians (RCP) produced a report which reviewed all available literature relating, among others, to the various techniques available for measuring bone density. This recommended that the basis for the diagnosis of osteoporosis should be the use of such techniques rather than alternative options such as quantitative ultrasound or computed tomography. The latter techniques, however, can be used as independent assessments of fracture risk. The general thrust of the RCP Report was that a preventative strategy for osteoporosis be directed towards selective case findings rather than adopting population-based strategies designed to reduce the risk of fracture in the general population e.g. by advocating increased levels of physical activity, reduced smoking habit, and increased dietary calcium, etc. It is considered that the evidence for the effectiveness of such interventions on fracture risk coupled with the compounding effect of poor compliance, with such strategies was such that the writing group could not endorse such an approach. Official support for the use of bone densitometry followed the recommendations in the AGO Report and the subsequent instructions issued in the NHS Executive Letter (1996) 1110 which gave responsibility to local Health Authorities to “purchase bone densitometry measurements by means of dual X-ray absorptiometry for particular clinical indications.” |
