policymakers. In addition, the effects of mid-life actions on subsequent medical costs to corporations for osteoporosis and fractures among their retirees should be documented and disseminated.

Providers

Treatment guidelines for osteoporosis screening and prophylaxis should be widely disseminated, and physicians, nurses, therapists, and other care providers should be educated regarding the need for and techniques of rehabilitation. Particular attention should be given to preventing vitamin D deficiency in the housebound elderly.

The Public

Women should be informed about the circumstances (risk factors, etc.) under which they should seek assessment for osteoporosis. Healthy lifestyles should be promoted (although there is no certainty that this will significantly reduce fracture occurrence), with an emphasis on good nutrition (including adequate intake of calcium and vitamin D), increased exercise, and decreased smoking and alcohol use. Practical information regarding calcium supplementation (preparation, dosages, etc.) should also be disseminated.

APPENDIX

SCREENING TESTS FOR OSTEOPOROSIS

Many different techniques have been used to assess bone mass. The most widely available, as well as the most accurate and precise, methods include single-photon absorptiometry, dual-photon absorptiometry, and quantitative computed tomography. These have been reviewed extensively (see P. L. Kimmel, "Radiologic Methods to Evaluate Bone Mineral Content, "Annals of Internal Medicine, Vol. 100, pp. 908-911, 1984); thus, only those aspects especially pertinent to screening are summarized here, along with features of the newest modality, dual-energy x-ray absorptiometry. Much of the information in the appendix is taken from two reports from the National Center for Health Services Research and Health Care Technology (M. Erlichman, Dual Photon Absorptiometry for Measuring Bone Mineral Density and Single Photon Absorptiometry for Measuring Bone Mineral Density, Health Technology Assessment Reports No. 6 and 7, respectively, U. S. Department of Health and Human Services, Rockville, Md., 1986).



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