Classification of osteoporosis and osteopenia in men is dependent on site-specific analysis.

To examine the diagnosis of osteoporosis and osteopenia in men based on bone density measurements at single or multiple sites using central and peripheral measurements, we studied 206 ambulatory, community-dwelling men over age 50. Bone mineral density of the hip, PA spine, forearm, and finger were assessed by dual-energy X-ray absorptiometry. The diagnosis of osteoporosis based on a single measurement ranged from 1% using the trochanter to 39% using Ward's triangle. Twenty-one percent of men had osteoporosis if the diagnosis was based on at least one osteoporotic value at three central sites (PA spine, total hip, femoral neck). Among these men using T-scores provided by the manufacturers, 51% of osteoporotic patients would be misclassified as normal using the accuDEXA((R)) (finger), and 37% of osteoporotic men would be misclassified as normal using the PA spine. We conclude depending on the number and selection of sites there is considerable variability in the classification and misclassification of osteoporosis and osteopenia in men.

Conflicting agendas, interests, and actors in disease prevention policy-making: business, labor, and the High Risk Act.

During 1985-1988, the U.S. Congress considered and nearly passed the controversial "High Risk Act." This article analyzes the case in terms of a class-dialectic perspective that views contradictory class interests, the political economy context, intraclass divisions, and institutional biases favoring dominant class interests as important, underlying factors in shaping the character, course, and outcome of the policy-making process. These concepts are used as the basis for explicating the political conflicts surrounding the legislation, the course of its consideration by the Congress, and its ultimate defeat. The sharp labor-business conflicts over the bills are shown to be closely tied to the legislation's potential effects upon their class-based economic and ideological/political interests. The course of Congressional consideration of the legislation is demonstrated as strongly influenced by contextual factors and intraclass divisions, especially those within the business community. Finally, indirect and direct institutional biases favoring business interests are shown to be particularly relevant to the legislation's defeat. In conclusion, the author develops a series of lessons regarding the disease prevention policy-making process which illustrate how the political dynamics and outcomes associated with episodes of occupational health policy reform may be interpreted through a class-dialectic perspective focusing upon class interests, divisions, and struggle.