Editor, – I recently read an editorial written by Associate Professor R. Prince (Aust Prescr1997;20:82-3) entitled 'Outcomes of the Australian Osteoporosis Consensus Conference'. In it the Professor stated that 'hip fracture kills as many women as breast cancer'.
Could you please provide me with the evidence for this statement?
Larry Light
General Practitioner
Middle Park, Vic.
Associate Professor R. Prince, the author of the editorial, comments:
Dr Light highlights an important issue, poorly understood by many medical practitioners in Australia and indeed worldwide. The issue relates to the relative likelihood of death from various diseases amongst their ageing patients. With this concept in mind, Elizabeth Geelhoed and myself set out to evaluate these issues in the Australian population and then calculate the effect of oestrogen replacement therapy on instance rates and mortality.
To do this, Ms Geelhoed obtained a data set from the Australian Institute of Health and Welfare comprising mortality events for coronary heart disease, stroke, breast cancer and endometrial cancer. Hip fracture mortality was calculated from Western Australian data. Using population sizes, rates for mortality in 1993 were calculated. These data were used in a conditional probability analysis based on a cohort of 50 year old women whose mortality was modelled for 50 years. On the basis of this analysis, it is clear that2.7% of the subjects will die from a hip fracture and 2.8% will die from breast cancer. I should also add that the mortality from breast cancer occurs at an earlier age than for hip fracture. These data have been published in part in the Proceedings of the International Menopause Society Symposium in Sydney.1
Editor, – The editorial 'Outcomes of the Australian Osteoporosis Consensus Conference' (Aust Prescr 1997;20:82-3) outlined that the prophylaxis and treatment of osteoporosis is aimed at reducing bone fractures, in particular hip fracture. The paragraph headed 'Prevention' listed all those measures taken in a multiple factorial approach to falls prevention. In a practice of vascular surgery, we constantly see elderly people for assessment of peripheral vascular disease because of various symptoms, often due entirely to musculoskeletal problems such as osteoarthritis, and often associated with musculoskeletal problems. It is not uncommon to see postmenopausal women tottering into the consulting room on narrow-based, poorly structured footwear, often even with high heels! Many of these have already had hips and knees replaced and they are still on their high heels!
Neither your editorial nor the recent consensus statement on osteoporosis addressed the issue of inappropriate footwear in postmenopausal women. I wonder if some of the money spent on prophylactic medication would be better spent on simple footwear education. The very make-up of the shoe can reduce the potential risk of slips and trips in and outside the home. By encouraging wider- based supportive footwear, not only would the issue of prevention and reduction of hip fractures be addressed, but also the potential judicious spin-off in the prevention of ulcerations and infections in the diabetic foot.
M.M. Lawrence-Brown
F.J. Prendergast
M.A. Goodman
K. Sieunarine
Vascular Surgery Department
and
J. Cornwell
Podiatry Department
Royal Perth Hospital
Perth, W.A.
