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offered exposure to positive suggestions during general anaesthesia. This would give patients the beneficial effect of the positive suggestions and protect them from the negative effects of "hearing" adverse or negative comments. Main outcome measure-Bone mineral density in the lumbar spine (L1-L4) as measured by dual energy x ray absorptiometry.Results-The amenorrhoeic group showed a mean reduction in bone mineral density of 15% (95% confidence interval 12% to 18%) as compared with controls (mean bone mineral density 0-89 (SD 0-12) g/cm2 v 1.05 (0-09) g/cm2 in controls). Bone loss was related to the duration of amenorrhoea and the severity of oestrogen deficiency rather than to the underlying diagnosis. Patients with a history of fracture had significantly lower bone density than those without a history of fracture. Ten patients had suffered an apparently atraumatic fracture.Conclusions-Amenorrhoea in young women should be investigated and treated to prevent bone mineral loss. Menopausal women with a past history of amenorrhoea should be considered to be at high risk of osteoporosis. IntroductionOsteoporosis is a major cause of morbidity and indirectly of mortality in Western women. It has been estimated that 40% of postmenopausal women sustain at least one osteoporotic fracture' 2 and that the cost to the NHS of treating hip fractures alone is £160m a year.' Loss of bone mineral is a major risk factor for fracture.4 Demineralisation is related to age, but women have accelerated bone loss with loss of ovarian function at the menopause.5 Osteoporotic fractures are rare in young women. Vertebral crush fractures and histologically proved osteoporosis have, however, been reported in young women with anorexia nervosa and amenorrhoea.6

Dual energy x ray absorptiometry and a wide range of blood and urine tests were used to assess the propensity ofpatients with systemic lupus erythematosus to develop an impairment of bone mineral density. Surprisingly, in this preliminary study no significant differences in bone mineral density were found when patients taking 10 mg or more of prednisolone for six months or longer were compared with those who had never taken prednisolone.