Comment on: Serum leptin and ghrelin correlate with disease activity in ANCA-associated vasculitis
Abstract
1736 Rheumatology 2008;47:1736 doi:10.1093/rheumatology/ken358 Advance Access publication 30 August 2008 Letters to the Editor 7 Kaptoge S, Benevolenskaya LI, Bhalla AK et al. Low BMD is less predictive than reported falls for future limb fractures in women across Europe: results from the European Prospective Osteoporosis Study. Bone 2005;36:387â98. Comment on: NICE guidance does not tally with clinical practiceâa district general experience: reply SIR, Many thanks for giving us the opportunity to comment on the observations of Yeap [1] on our letter [2]. His observations are valid about BMD not being the best marker for osteoporosis. It is, however, a flawed assumption that a prior fragility fracture is the only marker for future fracture. We know that what is frequently reported as a fragility fracture in the elderly might not be so [3]. Yeap advocates the recently published European guidance for the management of osteoporosis in post-menopausal women, which propose that treatment can be instigated after a fragility fracture, with or without BMD assessment [4]. This is pragmatic advice that may be partly related to the limited provision of dual energy X-ray absorbtiometry services. Our data included all fragility fractures including hip, wrist, vertebra and rib, while most of