Hormone replacement therapy and prevention of osteoporosis: risk assessment and practical advice

A review of the Debrecen Regional Osteoporosis Program (DROP) in Hungary is given, with special reference to the detection of postmenopausal osteoporosis (PMOP) and its treatment by hormone replacement therapy (HRT). The new definition of osteoporosis by focusing on bone mineral density (BMD) measurements has the major advantage of practical usefulness. The algorithm of managing osteoporotic patients can be easily constructed from the result of bone densitometry as the primary diagnostic tool. The DROP serves a total population of 550,000, is equipped with a DXA bone densitometer, a bone metabolism laboratory and backed by a multidisciplinary team of clinicians from gynecology, radiology, rheumatology, internal medicine, and orthopedic surgery. In 1995 the total number of patients undergoing densitometry was 3170. In 2045 patients T scores of -1 or below were found. From this total number, 348 patients received HRT for 1 year or longer. The results of the treatment showed a positive response (i.e. no bone loss, or net gain) in 65%, while half of the 'non responders' proved in fact non compliant. The contradiction between risk assessment and early diagnosis is explained and replacing 'risk assessment' by 'selection criteria for bone densitometry' is proposed. 'Prevention of osteoporosis' is also to be replaced by 'prevention of complications', i.e. osteoporotic fractures. One of these measures is HRT. Its rational use in the prevention and treatment of osteoporosis and its relation to other treatment methods in the authors' own experience is discussed.