Compliance with hormone replacement therapy (HRT) after screening for post menopausal osteoporosis

Abstract

Objective: To assess compliance with recommendations for hormone replacement therapy (HRT) in postmenopausal women following screening for osteoporosis.

Design: A postal questionnaire sent to women an average of 8 months (range 6-12) following measurement of their bone mineral density (BMD), and recommendations regarding HRT given to the referring general practitioner.

Setting: Referrals from local general practitioners. Mixed social class.

Subjects: 400 postmenopausal women aged 40-69 years (average age 52).

Main outcome measures: Compliance with advice and if failing to comply, reasons for not doing so.

Results: Replies were received from 352 women (88%) and 74% of respondents followed advice to start, continue, or refrain from starting or continuing HRT with regard to protecting their skeleton. Those who rejected advice to take HRT mostly had concern over side effects or the efficacy or safety of treatment. Of the women who started HRT 28% subsequently stopped, the principal reasons being withdrawal bleeding and weight gain. Of the women recommended to take HRT, 39% were not taking treatment by 8 months after referral, either because they ignored advice given (22%) or because of side effects (17%).

Conclusions: Screening leads to increased usage of HRT among women at most risk for osteoporosis. However, almost 40% of women with low bone mineral density were not taking HRT 8 months after referral, and therefore until improved compliance has been demonstrated screening cannot be widely recommended.