Effect of bone density evaluation on hormone replacement therapy prescription
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S Rozenberg1, M Kroll, J Vandromme
1Interdisciplinary Group on Osteoporosis, Free Universities of Brussels (VUB-ULB), St Peter Hospital, Brussels, Belgium.
Insights
Bone Mineral Density (BMD) results influenced hormone replacement therapy (HRT) prescription in a limited number of postmenopausal women and physicians. While lower BMD showed a trend towards increased HRT prescription, it was not a significant factor for most.
Area of Science:
- Endocrinology and Metabolism
- Women's Health
- Medical Decision Making
Background:
- Postmenopausal hormone replacement therapy (HRT) is a common treatment for various symptoms.
- Bone Mineral Density (BMD) is a key indicator of osteoporosis risk in postmenopausal women.
- The influence of BMD results on HRT prescription decisions requires further investigation.
Purpose of the Study:
- To evaluate the impact of Bone Mineral Density (BMD) test results on the prescription of hormone replacement therapy (HRT).
- To determine if gynaecologists' HRT prescription patterns are influenced by varying BMD levels in simulated postmenopausal cases.
Main Methods:
- 29 postmenopausal women's charts were used to create 4 simulated case groups with differing BMD Z-scores.
- 10 gynaecologists assessed these simulated cases for HRT prescription eligibility, unaware of the BMD manipulation.
- Statistical analyses, including Friedman analysis of variance and Cochran Q test, were employed.
Main Results:
- An overall HRT treatment rate of 74.2% was observed, with higher rates in groups with lower BMD.
- A significant variation in prescription frequency was noted among the 10 gynaecologists (63%-87%).
- BMD results influenced HRT prescription in a statistically significant manner for only one physician.
Conclusions:
- BMD measurement appears to be a determinant factor for HRT prescription in a limited patient and physician subset.
- BMD may aid in decision-making for HRT, particularly for reluctant patients or those with relative contraindications.
- Physician awareness of BMD investigation utility could enhance its role in guiding HRT decisions.
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.