Interpreting the science

Although the chances of predicting a preventable fracture by bone densitometry may be small, it is also important that two thirds of patients can be reassured that fracture is less likely and therefore long term treatment is not needed. That there is overuse, overdiagnosis, and overtreatment for osteoporosis is due not to bone densitometry or to epidemiological reports but to various factors, including pressure of some competing pharmaceutical companies and the uncritical medical society relying more on technical instrumentation than on clinical skills and reasoning. As Wilkin and Devendra assert above, effectiveness is critical in daily clinical practice.—Jan Dequeker, Frank P Luyten