Abstract
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.
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- Cummings S. R., Nevitt M. C., Browner W. S., Stone K., Fox K. M., Ensrud K. E., Cauley J., Black D., Vogt T. M. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995 Mar 23;332(12):767–773. doi: 10.1056/NEJM199503233321202. [DOI] [PubMed] [Google Scholar]
- Grady D., Rubin S. M., Petitti D. B., Fox C. S., Black D., Ettinger B., Ernster V. L., Cummings S. R. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992 Dec 15;117(12):1016–1037. doi: 10.7326/0003-4819-117-12-1016. [DOI] [PubMed] [Google Scholar]
- Holbrook T. L., Barrett-Connor E., Wingard D. L. Dietary calcium and risk of hip fracture: 14-year prospective population study. Lancet. 1988 Nov 5;2(8619):1046–1049. doi: 10.1016/s0140-6736(88)90065-7. [DOI] [PubMed] [Google Scholar]
- Hui S. L., Slemenda C. W., Johnston C. C., Jr Age and bone mass as predictors of fracture in a prospective study. J Clin Invest. 1988 Jun;81(6):1804–1809. doi: 10.1172/JCI113523. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Connor A. M. Validation of a decisional conflict scale. Med Decis Making. 1995 Jan-Mar;15(1):25–30. doi: 10.1177/0272989X9501500105. [DOI] [PubMed] [Google Scholar]
- Paganini-Hill A., Chao A., Ross R. K., Henderson B. E. Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology. 1991 Jan;2(1):16–25. doi: 10.1097/00001648-199101000-00004. [DOI] [PubMed] [Google Scholar]
- Ross P. D., Davis J. W., Epstein R. S., Wasnich R. D. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991 Jun 1;114(11):919–923. doi: 10.7326/0003-4819-114-11-919. [DOI] [PubMed] [Google Scholar]
- Rubin S. M., Cummings S. R. Results of bone densitometry affect women's decisions about taking measures to prevent fractures. Ann Intern Med. 1992 Jun 15;116(12 Pt 1):990–995. doi: 10.7326/0003-4819-116-12-990. [DOI] [PubMed] [Google Scholar]
- Seeley D. G., Browner W. S., Nevitt M. C., Genant H. K., Scott J. C., Cummings S. R. Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med. 1991 Dec 1;115(11):837–842. doi: 10.7326/0003-4819-115-11-837. [DOI] [PubMed] [Google Scholar]