To the Editor: Complementary and alternative medicine (CAM)1 has become increasingly popular, with Australians spending an estimated $1.8 billion on CAM per year.2

We conducted a prospective study to determine the prevalence and patterns of CAM use among Australian patients with osteoporosis and to identify demographic, socioeconomic and disease-specific features that predict its use. A recent Canadian study of 360 patients with osteoporosis showed that 57% used CAM; CAM users tended to be younger than non-users and better educated, but with a lower quality-of-life score for mental health.3 To our knowledge, there have been no similar studies carried out in Australia.

We surveyed 202 randomly selected patients of a Sydney tertiary hospital osteoporosis clinic over a 10-month period (March to December 2007). The clinic sees a wide spectrum of people, from healthy postmenopausal women to patients with multiple comorbidities. At their routine clinic visits, participants completed a prospective questionnaire based on previous CAM therapy surveys.3,4 They were asked about use of CAM, reasons for use, cost, perceived benefits, household income, medical insurance status and educational background. Ethics approval for the survey was obtained from the hospital’s ethics review board.

The mean age of participants was 68.5 years (SD, 10.9 years); 80% were women; and 56% were born overseas. We analysed responses using firstly a fairly broad “standard” definition of CAM (including all therapies listed in the Box), and then a more stringent definition that excluded hypnosis, multivitamin therapy, tai chi and yoga. CAM use was reported by 104 patients (51%) and 62 patients (31%) based on the standard and stringent definitions, respectively. Comparative popularity of the CAM therapies used by the surveyed patients is shown in the Box. Common reasons for CAM usage were its holistic approach (53%) and the perception that conventional therapy was providing inadequate pain control (29%). Seventy-three per cent of respondents did not consult a physician before starting CAM, and 23% stated that their treating specialists were unaware of their CAM use. Eighty-eight per cent paid for their therapies out of pocket and the mean cost per patient per month was $21. (Given that 2.2 million Australians have an osteoporosis-related condition5 and 51% of these patients use CAM, the estimated annual expenditure on CAM therapies by patients with osteoporosis is $696 million.)

CAM users were more likely than non-CAM users to be university-educated (26% v 14%; P = 0.05); to be born in Asia (20% v 13%; P = 0.03); to have a lower lumbar spine bone mineral density T score (mean, − 2.35 SD v − 2.20 SD; P = 0.05); and to make more frequent clinic visits (mean T score, 1.8 v 1.5 visits /12 months; P = 0.03). More than half the respondents (57%) were unable to differentiate between the terms “osteoporosis” and “osteoarthritis”, especially those from a non-English-speaking background (64% compared with 46% of patients from English-speaking backgrounds; P = 0.02) and CAM non-users (57% compared with 41% of CAM users; P = 0.01).

The proportion of patients using CAM in our study was comparable to the proportion in a similar Canadian cohort (51% v 57%).3 Patients who resort to CAM for pain relief may be suffering residual fracture pain or coexisting conditions, such as osteoarthritis; patients unable to differentiate between osteoporosis and osteoarthritis may be seeking relief from pain caused by the latter. Given the low rate of patient disclosure of CAM use to physicians in our study and the reasonable chance of interaction between CAM and conventional therapies (17%),3 physicians would be prudent to regularly and clearly discuss concurrent CAM use with patients (using interpreters when necessary) to avoid potentially harmful drug interactions and side effects. At the same time, physicians could recommend appropriate balance-training therapies,6 such as tai chi, which has been shown to improve bone health and prevent falls.7