1. The patient did not have severe disease. According the the WHO criteria, she had osteopenia at her hip and osteoporosis at her spine. It was not severe, because she did not have any fractures. The WHO specifically made a separate category for women with fractures, and the terms "severe" or "established" should only be used when a patient has had a non-traumatic fracture.
This is an important distinction because the risk for another fracture is 4 times greater in a woman who already has a fracture than in a woman with the same bone density who does not have a fracture.