Women's decisions about hormone replacement therapy after education and bone densitometry.
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.


CONCLUSIONS
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.
Papaioannou
A
A
School of Rehabilitation Science, McMaster University, Hamilton, Ont.
Parkinson
W
W
Adachi
J
J
O'Connor
A
A
Jolly
E E
EE
Tugwell
P
P
Bédard
M
M
D015502:Absorptiometry, Photon; D015519:Bone Density; D003657:Decision Making; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014930:Women / Q000193:education* / Q000523:psychology*