Programs designed to screen perimenopausal women for low bone density are controversial. After screening, women are often given hormone replacement therapy and may be labeled at “high risk” for osteoporosis, which may have a negative impact on their quality of life. From a cost perspective, the most significant expense of a screening program is the hormone replacement therapy, not the cost of measuring bone mineral density (BMD). Torgerson and colleagues evaluated the effect of a screening program on the use of hormone replacement therapy and quality of life.
A total of 1,600 women were selected from a community health index and randomized to either a BMD screening group or a control group. All of the women were 45 to 54 years of age. Women in the screening group were tested and advised of their BMD status, and received lifestyle advice from their physicians. Women in the control group were not screened or contacted at baseline. Baseline characteristics, including height, weight, educational level and history of hysterectomy, were similar in both groups. Two years later, the same women were surveyed to determine use of hormone replacement therapy and quality of life issues. A total of 607 women (76 percent) in the control group and 613 (77 percent) in the screening group completed this survey questionnaire.
Current use of hormone replacement therapy was significantly higher in the screening group than in the control group. A greater proportion of the women receiving hormone therapy cited low BMD or prevention of osteoporosis as the reason for therapy. Women with the lowest BMD in the screening group had a 19 percent increase in the use of hormone replacement therapy compared with women in the control group. In fact, these women were approximately 2.5 times more likely than women in the control group to receive hormone replacement therapy.
The use of therapy also tended to increase with age. The incidence of hormone replacement therapy use did not differ between groups in women 47 to 51 years of age; however, in women 52 to 56 years of age, there was a significant increase in therapy use (13 percent). Quality of life scores and self-reported fall and fracture rates did not differ between groups.
The authors conclude that BMD screening results in a modest increase in the use of hormone replacement therapy and that this increase becomes more evident as women age. However, after two years, screening did not appear to have any effect on quality-of-life issues, although this may change with a longer-term study. The study showed no fracture-related benefits of screening, but such benefits may not be apparent within two years of initial BMD measurements.