Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures.

Objective: To analyse whether bone mineral density (BMD) assessment is required in postmenopausal women presenting with low trauma vertebral fracture. Methods: Women with vertebral fracture diagnosed over a 10 year period were recruited from our database. The following were excluded: (a) patients with high energy trauma; (b) patients with malignancies; (c) patients with a metabolic bone disease other than osteoporosis. All postmenopausal women were included in whom BMD had been evaluated at both the lumbar spine and femoral neck by dual energy x ray absorptiometry during the six months after the diagnosis. Patients with a potential cause of osteoporosis other than age and menopause were not considered. A total of 215 patients were identified. Results: The mean (SD) age of the patients was 65.9 (6.9) years. BMD at the lumbar spine was 0.725 (0.128) g/cm2 and the T score was ¿2.94 (1.22); BMD at the femoral neck was 0.598 (0.095) g/cm2 and the T score was ¿2.22 (0.89). The BMD of the patients was significantly lower than that of the general population at both the lumbar spine and femoral neck. When the lowest value of the two analysed zones was considered, six patients (3%) showed a normal BMD, 51 (23.5%) osteopenia, and 158 (73.5%) osteoporosis. The prevalence of osteoporosis at the femoral neck increased with age; it was 25% in patients under 60, 35% in patients aged 60¿70, and 60% in patients over 70. Conclusion: These results indicate that bone densitometry is not required in postmenopausal women with clinically diagnosed vertebral fractures if it is performed only to confirm the existence of a low BMD.

Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry.

Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed. METHODS DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population. RESULTS The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score ¿¿2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%. CONCLUSIONS The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.

Unnatural Mothers, Mothering Unnaturally: Technologies of Reproduction and the Politics of Maternity in Hiromi Goto's "Hopeful Monsters"

Through scientific discourse and reproductive technologies, the reproductive body and the maternal body continue to be constructed as ‘natural’. At the same time,these technologies have begun to blur the boundaries between what is consideredan acceptable reproductive body, and consequently an acceptable maternal body,and an unnatural or a socially undesireable one. As science purports to offerwomen greater control over how and when they choose to procreate, through methods which range between delaying or eliminating the possibility of contraception to those which extend the possibility of conception to postmenopausal or infertile women, these same procedures raise questions about thenature and ‘naturalness’ of reproduction. Added to these concerns are thesuitablility of the reproductive body as a maternal body. Consequently, and moreand more frequently, bodies which defy ideals about maternity and motherhoodemerge, and questions about what it means to mother are raised. Bodies whichcontest the construction of motherhood as natural are frequently represented asmonstrous or freakish, and the debate between science and nature is heightened.Hiromi Goto’s short story ‘Hopeful Monsters’ resists the construction of the‘natural’ maternal body by highlighting the way in which women’s bodies areshaped by scientific discourse. In turn, images of ‘monstrous’ mothers emerge andare challenged, suggesting the need to reimagine what it means to mother and whatit means to be a mother. Through reading a selection of the stories this paper willinterrogate possible alternatives to constructions of the ‘natural’ maternal body and motherhood, suggesting that the Goto’s ‘monsters’ are perhaps only monstrous as a result of scientific discourse which constructs them as such.