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Byline: R. G. Crilly (1), R. J. Sebaldt (2), A. B. Hodsman (3), J. D. Adachi (4), J. P. Brown (5), C. H. Goldsmith (6), D. A. Hanley (8), W. O. Olszynski (9), L.-G. Ste-Marie (11), G. F. Stephenson (12) Keywords: Key words:Bone mineral density -- Etidronate -- Osteoporosis Abstract: We investigated whether an increase in lumbar spine bone mineral density (LS BMD) at 6 months or at 12 months could predict the response to intermittent cyclical therapy (ICT) with etidronate, defined in one of two ways: (i) an increase in LS BMD at 24 months (improvement) or (ii) an increase in LS BMD aY=0.028 g/cm.sup.2 (significant improvement). The latter is a precision term calculated from test--retest values for LS BMD in osteoporotic patients. Two hundred and forty-seven patients (32 men 5 premenopausal and 210 postmenopausal women) were followed for 24 months by dual-energy X-ray absorptiometry (DXA) and were not taking estrogen, calcitonin or fluoride during treatment with ICT-etidronate. One hundred and fifty patients had a LS BMD measurement after 6 months of treatment with ICT-etidronate and 205 patients had one at 12 months. Baseline characteristics (mean SD) were as follows: age, 66 11 years years since menopause, 21 10 number of vertebral fractures at baseline, 0.87 1.26 LS BMD T-score, -2.8 1.2. After 24 months of treatment with ICT-etidronate, 81% of the patients had an improvement, and 55% had a significant improvement at the LS. Only 6% significantly lost bone (loss of 0.028 g/cm.sup.2 or more). The mean percent change from baseline in LS BMD was 5.1% (95% confidence interval 4.2% to 6.0%). The results for men and postmenopausal women were similar to those for the entire group. Accuracy and sensitivity were marginally, but not significantly, higher when response was predicted using 12 month versus 6 month LS BMD measurements. The positive predictive values of improvement at 6 or 12 months were 89% and 90% respectively for improvement at 24 months, and 66% and 68% for significant improvement at 24 months. Identification of nonresponders was less successful and similar at 6 months and 12 months. Forty percent and 39% of the patients, who had no improvement at 6 or 12 months respectively, also had no improvement at 24 months, i.e., were true negatives, while 77% and 71% had no significant improvement at 24 months. The results may reflect slow response in a small subgroup of patients rather than nonresponse however, no response at 1 year might identify patients whose rate of response is sufficiently slow that alternative therapy is justified. These data demonstrate a good response rate to ICT-etidronate and may help reduce the need for follow-up BMD measurements in those who show an early improvement. Author Affiliation: (1) Department of Geriatric Medicine, University of Western Ontario, London, ON, CA (2) Division of Rheumatology, Department of Medicine, McMaster University, St Joseph's Hospital, Hamilton, ON, CA (3) Department of Medicine, University of Western Ontario, St. Joseph's Health Centre, London, ON, CA (4) Rheumatic Disease Unit, McMaster University, St Joseph's Hospital, East Hamilton, ON, CA (5) Laval University, Le Centre hospitalier universitaire de QueA'bec, Ste-Foy, PQ, CA (6) Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, CA (7) Father Sean O'Sullivan Research Centre, St Joseph's Hospital, Hamilton, ON, CA (8) Division of Endocrinology and Metabolism. Department of Medicine, University of Calgary Faculty of Medicine, Calgary, AB, CA (9) Department of Medicine, University of Saskatchewan, Saskatoon, SK, CA (10) Saskatoon Osteoporosis Centre, Saskatoon, SK, CA (11) UniversiteA' de Montreal, CHUM, Saint-Luc Campus, Montreal, PQ, CA (12) Procter &amp Gamble Pharmaceuticals Canada, Inc., Toronto, ON, Canada, CA Article note: Received: 12 November 1999 / Accepted: 3 January 2000

Many terms are used to describe older individuals. How these terms are perceived by older individuals is not known. The purpose of this study was to determine how older individuals feel about these designations. A survey using a 6-point Likert scale was used to measure responses to different terms. Overwhelmingly respondents preferred the terms 'seniors' (m=4.80; S.D.=1.40) and 'senior citizens' (m=4.50; S.D.=1.46). Least liked was 'geriatric' (m=1.89; S.D.=1.19). Fifty-four percent of respondents listed 'geriatric' as totally unacceptable. These findings raise the possibility that seniors' acceptance of geriatric services may be adversely affected by the terminology used.