Opinions and experiences in general practice on osteoporosis prevention, diagnosis and management.

We determined to survey the general practice population regarding their attitudes to and knowledge of osteoporosis as a baseline prior to publication of national guidelines for the management of osteoporosis. All 2515 general practitioners registered in the 10 Health Authorities of the North Thames region, London, UK were surveyed by a postal questionnaire. Responses relating to epidemiology, public health and education on osteoporosis were analyzed. The overall response was 1153 (46%). General practitioners who responded were younger, predominantly female and in group practice. There is considerable awareness of the importance of preventing osteoporosis. General practitioners are active in identifying groups at risk, particularly those who are aged 40 years and older. A prevention strategy for osteoporosis is viewed as effective. However, two thirds of general practitioners remain unconvinced about the efficacy of drug therapy. Education on osteoporosis is considered inadequate. General practitioners would welcome further information on management issues and access to osteoporosis services. In conclusion, educational initiatives will be important both at undergraduate and postgraduate levels to increase awareness and knowledge of osteoporosis. General practitioners are aware of the public health impact of this condition and express a preference for educational material of direct relevance to the care of their patients. Therefore better cooperation between primary and secondary care should lead to ways of breaking down barriers to change in clinical practice and promoting fully integrated care of patients with osteoporosis.

Renal gallium accumulation in the absence of renal pathology in patients with severe hepatocellular disease.

Visualization of Ga-67 citrate in the kidneys at 48 hours and 72 hours post injection is usually interpreted as evidence of renal pathology. In reviewing approximately 200 consecutive patients referred for gallium scans, 40 patients who also underwent liver/spleen Tc-99m sulfur colloid (SC) studies within one month of the gallium study were identified. Fourteen of these patients showed advanced hepatocellular dysfunction on the Tc-99m SC liver/spleen images. Of these 14 patients, nine had persistent renal accumulation of gallium at 48 or 72 hours. Five of these nine patients had no evidence of primary renal disease by clinical or postmortem examination and subsequent clinical information indicated that two additional patients probably had no significant renal pathology. Therefore, bilateral symmetrically increased renal uptake of gallium in patients with advanced hepatocellular disease should not necessarily be interpreted as evidence of renal pathology.