Rozenberg S, Kroll M, Vandromme J, Paesmans M, Ham H
Interdisciplinary Group on Osteoporosis, Free Universities of Brussels (VUB-ULB), St Peter Hospital, Brussels, Belgium.
Maturitas. 1996 May;24(1-2):57-61. doi: 10.1016/0378-5122(95)01002-5.
This study evaluates whether Bone Mineral Density (BMD) results influence HRT prescription.
Successive charts of 29 postmenopausal women were summarised. For each chart, 3 'simulated cases' were created by modifying the BMD result (based on the Z-score) in order to have 4 groups with the same clinical story but a wide range of BMD values (Group I = Z-score > 0, Group II = Z-score between 0 and -1, Group III = Z-score between -1 and -2 and Group IV = Z-score < -2). The obtained cases were presented to 10 gynaecologists who were asked whether HRT should be prescribed. The gynaecologists were not aware of the above-mentioned manipulation.
The overall treatment rate was 74.2%, ranging from 65% for women with the highest BMD (Group I), 73% for Group II, 79% for Group III and 80% for Group IV, i.e. women with the lowest BMD (Friedman analysis of variance; chi-square 17.2; P < 0.001). In approximately a third of the patients (11/29), there was agreement for initiation of therapy, regardless of the BMD. Most of these women presented other indications and no contra-indications for therapy. The prescription frequency of the 10 gynaecologists varied between 63% and 87%; Cochran Q Statistic 39.2; P < 0.0001). For some physicians, a trend to increase prescription was observed in relation to the BMD result, but a statistical difference could only be reached for one physician (P < 0.05). Furthermore, for some physicians no modification whatsoever could be observed.
BMD appears to be a determinant factor for HRT prescription in only a limited proportion of the patients and a small number of the physicians. From an epidemiological point of view, BMD measurements may be useful in order to help deciding women to start HRT, especially those who are reluctant or to those who present relative contra-indications, provided that their physicians are aware of the usefulness of these investigations.
本研究评估骨密度（BMD）结果是否会影响激素替代疗法（HRT）的处方。
总结了29名绝经后女性的连续病历。对于每份病历，通过修改BMD结果（基于Z评分）创建3个“模拟病例”，从而形成4组具有相同临床情况但BMD值范围广泛的病例（第一组=Z评分>0，第二组=Z评分在0至 -1之间，第三组=Z评分在 -1至 -2之间，第四组=Z评分< -2）。将得到的病例呈现给10名妇科医生，并询问他们是否应开具HRT处方。这些妇科医生并不知晓上述操作。
总体治疗率为74.2%，骨密度最高的女性（第一组）为65%，第二组为73%，第三组为79%，第四组为80%，即骨密度最低的女性（Friedman方差分析；卡方值17.2；P < 0.001）。在大约三分之一的患者（11/29）中，无论骨密度如何，对于开始治疗的意见是一致的。这些女性大多有其他治疗指征且无治疗禁忌证。10名妇科医生的处方频率在63%至87%之间变化；Cochran Q统计量为39.2；P < 0.0001）。对于一些医生而言，观察到有根据BMD结果增加处方的趋势，但只有一位医生达到了统计学差异（P < 0.05）。此外，对于一些医生，未观察到任何变化。
骨密度似乎只是在有限比例的患者和少数医生中是激素替代疗法处方的决定因素。从流行病学角度来看，骨密度测量可能有助于决定女性是否开始激素替代疗法，特别是对于那些犹豫不决或有相对禁忌证的女性，前提是她们的医生了解这些检查的有用性。
