title: Improving compliance with hormonal replacement therapy in primary osteoporosis prevention.
abstract: OBJECTIVE
  To evaluate whether introduction of treatment alternatives would improve compliance with hormonal replacement therapy (HRT) as primary osteoporosis prevention in women not tolerating the first line osteoporosis prevention schedule.
  
  
  METHODS
  Follow-up in four hospitals participating in the Danish Osteoporosis Prevention Study. A total of 706 peri- and postmenopausal women aged 45-57 years between 3 and 24 months from last menstrual bleeding took part, 489 women were randomised to HRT and 217 received HRT by personal choice. A total of 135 (19%) women were hysterectomised. HRT was given as oral or transdermal oestradiol supplemented with progestogen. If the initial treatment allocation was not acceptable several alternatives were available in a pragmatic approach.
  
  
  RESULTS
  Compliance with first treatment schedule was lower in women with intact uterus (at 5 years: 48.3 +/- 2.4% compliance) than in hysterectomised (64.7 +/- 5.8%, P < 0.001 in a Cox analysis) but did not differ after the introduction of HRT alternatives (67.0 +/- 2.9 vs 77.8 +/- 5.9, P = 0.12). Compliance decreased with increasing age at treatment start (RR = 1.11, P < 0.001) in women with intact uterus but not in hysterectomised women (P = 0.96). Headache/migraine was more frequent among women with intact uterus on oral sequential oestrogen plus progestogen than among hysterectomised women receiving oral continuous oestrogen (RR = 11.3, P < 0.01).
  
  
  CONCLUSIONS
  It seems possible to maintain a high HRT compliance by a pragmatic approach including offering alternative HRT formulations to women not tolerating the primary HRT. Further research into long-term compliance with HRT and cost-benefit is warranted.
authors.affiliation: Osteoporosis Clinic, Aarhus University Hospital, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Vestergaard
authors.forename: A P
authors.initials: AP
authors.lastname: Hermann
authors.forename: J
authors.initials: J
authors.lastname: Gram
authors.forename: L B
authors.initials: LB
authors.lastname: Jensen
authors.forename: N
authors.initials: N
authors.lastname: Kolthoff
authors.forename: B
authors.initials: B
authors.lastname: Abrahamsen
authors.forename: C
authors.initials: C
authors.lastname: Brot
authors.forename: P
authors.initials: P
authors.lastname: Eiken
mesh_terms: D015331:Cohort Studies; D015914:Estrogen Replacement Therapy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000517:prevention & control*; D010349:Patient Compliance; D017698:Postmenopause / Q000187:drug effects* / Q000502:physiology / Q000523:psychology; D012923:Social Class; D013997:Time Factors