PATIENT STORY: Esther is a 74-year-old woman from Co Galway. She is married with three grown-up children and lives with her husband on the outskirts of a village.

With a four-year history of back pain, her general practitioner referred her to Dr Robert Coughlan, consultant rheumatologist in Merlin Park Hospital in Galway.

The pain was worse when standing and sitting, but she was almost pain-free lying down.

Esther's back felt tired all the time and recently she began to feel pain in her side from mid- afternoon every day.

One of her daughters had noticed Esther becoming more stooped and that she seemed to have lost some height.

She was also concerned at the intermittent severity of her mother's pain.

Esther's medical history included a previous fracture of her right wrist.

Clinical examination showed Esther had a typical osteoporotic posture - she had a marked stoop and her upper back was curved into what is termed "a dowagers hump".

X-rays were carried out on her first visit. These showed that three of her lower back vertebrae were fractured and suggested that her lower ribs were pressing on her pelvis because of the extent of her loss of height.

A subsequent assessment of Esther's bone density confirmed the presence of severe osteoporosis.

Following three years of treatment with calcium, vitamin D and a biphosphonate agent, Esther's back pain has disappeared, except for a slight ache if she stands for long periods.

She has had no further fractures and the latest measurement of bone density shows a considerable improvement on bone strength.

There are a number of lessons from Esther's story. Treatment for osteoporosis has greatly improved her quality of life. It has also prevented further fractures on her spine and has almost certainly prevented a hip fracture.

The consultation has also alerted her two daughters to consider a bone density assessment when they reach the menopause.

And it has also been an opportunity to encourage Esther's grandchildren to eat a diet rich in calcium.