Effect of bone density evaluation on hormone replacement therapy prescription.

OBJECTIVES

This study evaluates whether Bone Mineral Density (BMD) results influence HRT prescription.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.