Osteogenesis imperfecta after the menopause.

We studied the fracture rate as a function of age in 45 women and 20 men with osteogenesis imperfecta. In each variant of the disorder, the fracture rate in women peaked in childhood, declined in adolescence, and rose again after the menopause. In contrast, the fracture rate in men remained low after adolescence. After the menopause women were vulnerable to crush fractures of the spine as well as fractures of the long bones. We conclude that the increased fracture rate after the menopause in women with osteogenesis imperfecta reflects the superimposition of the effects of age-related bone loss on those of the defective collagen structure of osteogenesis imperfecta, and that hormone-replacement therapy may be specifically indicated in this group of patients from the time of the menopause. We also suggest that osteogenesis imperfecta should be included in the differential diagnosis of women presenting with crush fractures of the spine.

Morbidity from chronic asthma.

Seventy asthmatic patients newly referred to a hospital outpatient clinic have been studied. In one-third of the patients the diagnosis of asthma had not been considered. Eight patients presented with an FEV1 of one litre or less. Acute severe asthma is commonly believed to precede death from asthma, but patients with more chronic symptoms may have equally severe airways obstruction without appearing acutely ill. Failure to diagnose and treat such patients may be contributing to our present inability to reduce the death rate from asthma.