This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Donaldson, M. G.
Right arrow Articles by Wark, J. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Donaldson, M. G.
Right arrow Articles by Wark, J. D.
CMAJ • August 7, 2001; 165 (3)
© 2001 Canadian Medical Association or its licensors

Letters
Correspondance

Be careful with the term "bone loss"

Meghan G. Donaldson, Karim M. Khan, Heather A. McKay and John D. Wark

Osteoporosis Program BC Women's Hospital and Health Centre Vancouver, BC; Department of Family Practice University of British Columbia Vancouver, BC; School of Human Kinetics University of British Columbia Vancouver, BC; Department of Medicine University of Melbourne Melbourne, Australia

We congratulate Nicole Fitt and colleagues on their paper on the influence of bone densitometry on the treatment of osteoporosis.1 We concur with their recommendation that "physicians not merely tell their patients results but that they also facilitate an understanding of the results" and thus we feel obliged to draw attention to inappropriate use of the terms "bone loss" and "no bone loss" in the article.

"Bone loss" implies change over time. As Fitt and colleagues will certainly agree, "bone loss" is not synonymous with "low bone mass," just as "weight loss" is not synonymous with "thin." Unfortunately, the authors used the term "bone loss" to group subjects classified as having osteopenia or osteoporosis by a single dual-energy x-ray absorptiometry (DXA) scan. Similarly, they equated normal DXA scores with "no bone loss." Thus, they implicitly attributed a change vector to the DXA absorptiometry results.

A patient with osteoporosis or osteopenia is not necessarily losing any more bone than her counterparts with normal bone mass.2 But if this patient is told she has a DXA score that represents "bone loss" she might very reasonably misinterpret this to mean that the DXA scan reveals a recent trend for bone loss, and this might influence her choice of therapy. Thus, as physicians, we must be very cautious not to use language that may mislead the patient about our technology's ability to interpret the state of their bone mineral metabolism.

Please do not interpret this as a criticism of the excellent work of Fitt and colleagues. We agree entirely that patients and doctors must understand DXA results,3 as they must the results of any medical investigation,4 and thus it is important that physicians use accurate terminology when they report results to patients.

References

  1. Fitt NS, Mitchell SL, Cranney A, Gulenchyn K, Huang M, Tugwell P. Influence of bone densitometry results on the treatment of osteoporosis. CMAJ 2001;164(6):777-81.[Abstract/Free Full Text]
  2. Guthrie JR, Ebeling PR, Hopper JL, Barrett- Connor E, Dennerstein L, Dudley EC, et al. A prospective study of bone loss in menopausal Australian-born women. Osteoporos Int 1998;8(3):282-90.[Medline]
  3. White C, Pocock N. Bone density and osteoporosis: crunching more than numbers [editorial]. Aust NZ J Med 1997;27:519-20.[Medline]
  4. Khan KM, Tress BW, Hare WSC, Wark JD. "Treat the patient, not the X-ray": advances in diagnostic imaging do not replace the need for clinical interpretation [editorial]. Clin J Sport Med 1998;8:1-4.




This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Donaldson, M. G.
Right arrow Articles by Wark, J. D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Donaldson, M. G.
Right arrow Articles by Wark, J. D.