接受教育并进行骨密度测量后女性关于激素替代疗法的决定。
Women's decisions about hormone replacement therapy after education and bone densitometry.
作者信息
Papaioannou A, Parkinson W, Adachi J, O'Connor A, Jolly E E, Tugwell P, Bédard M
机构信息
School of Rehabilitation Science, McMaster University, Hamilton, Ont.
出版信息
CMAJ. 1998 Nov 17;159(10):1253-7.
BACKGROUND
The decisions that postmenopausal women make about whether to start hormone replacement therapy may depend on the potential risks and benefits of such therapy as well as their risk for osteoporosis-related fractures. This study examined the decisions made by women at risk for osteoporosis-related fractures who were educated about hormone replacement therapy and who were given information about their bone mineral density.
METHODS
The study employed a prospective cohort design. Thirty-seven post--menopausal women with risk factors for osteoporosis-related fractures were recruited from an orthopedic clinic at a teaching hospital in Hamilton, Ont. The women were given an education kit (consisting of an audio tape and a work-book) to clarify the benefits and risks of hormone replacement therapy. Two to 4 weeks later, densitometry of the hip and the lumbar spine was performed. A summary of the risks, the densitometry findings and decisions about hormone replacement therapy were given to the women's family physicians for follow-up. Outcome measures included decisions about hormone replacement therapy, as well as use of such therapy and other medications at 12 months.
RESULTS
After the education component alone, 10 (27%) of the women requested hormone replacement therapy. After densitometry testing, 4 more requested hormone replacement therapy (for a total of 14 women [38%]). At 12 months, 2 (5%) of the women had been lost to follow-up. Of the remaining 35, 6 (17%) were receiving hormone replacement therapy, 7 (20%) were using bisphosphonates, and 24 (68%) were taking calcium supplements.
INTERPRETATION
These preliminary findings suggest that the combination of education about hormone therapy and feedback about bone density is associated with an increase in the use of hormone replacement therapy and other preventive medications by women at risk for osteoporosis-related fractures. However, the observed increase was small and so the clinical significance must be confirmed and clarified.
背景
绝经后女性对于是否开始激素替代疗法的决定，可能取决于该疗法的潜在风险和益处，以及她们发生骨质疏松相关骨折的风险。本研究调查了有骨质疏松相关骨折风险的女性在接受激素替代疗法教育并得知其骨密度信息后所做的决定。
方法
本研究采用前瞻性队列设计。从安大略省汉密尔顿市一家教学医院的骨科诊所招募了37名有骨质疏松相关骨折风险因素的绝经后女性。给这些女性发放了一套教育资料（包括一盒录音带和一本工作手册），以阐明激素替代疗法的益处和风险。2至4周后，对髋部和腰椎进行骨密度测量。将风险总结、骨密度测量结果以及关于激素替代疗法的决定提供给这些女性的家庭医生以便随访。结局指标包括关于激素替代疗法的决定，以及12个月时该疗法和其他药物的使用情况。
结果
仅在接受教育部分后，10名（27%）女性要求进行激素替代疗法。在骨密度测量后，又有4名女性要求进行激素替代疗法（总共14名女性[38%]）。在12个月时, 2名（5%）女性失访。在其余35名女性中，6名（17%）正在接受激素替代疗法，7名（20%）正在使用双膦酸盐，24名（68%）正在服用钙补充剂。
解读
这些初步研究结果表明，激素疗法教育与骨密度反馈相结合，与有骨质疏松相关骨折风险的女性增加使用激素替代疗法和其他预防药物有关。然而，观察到的增加幅度较小，因此其临床意义必须得到证实和阐明。
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