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Ovarian failure after total body irradiation SIR,-Dr M P Cust and colleagues only touch on the possible long term effects of total body irradiation,' but these need to be addressed as increasing numbers of patients are successfully treated. We measured bone mineral content and density in the lumbar spine in 14 women who had premature ovarian failure after treatment for haematological malignancies. On average, 51 months had elapsed since treatment. We used a dual energy x ray absorption technique with a precision of 1%.2 The patients' mean vertebral bone density was 0 97 (SD 0 15) g/cm2; that of a control group' of 68 women in the same age range (19 to 45, mean age of both groups 33 years) was 1 07 (0 09) g/cm2 (p=004, Student's t test). The patient with the lowest bone mineral density (0 71 g/cm') had already suffered an atraumatic fracture of a metatarsal bone. The loss of almost 10% of bone mineral in this short time implies that these patients are at risk of developing osteoporosis in the future. We support the recommendation of Dr Cust and colleagues that they should be referred to a gynaecologist or endocrinologist to consider hormone replacement therapy.