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August 13, 1997

Facilitating Patient-Specific Decisions Regarding Hormone Replacement Therapy

Author Affiliations

Free Universities of Brussels Brussels, Belgium

JAMA. 1997;278(6):475. doi:10.1001/jama.1997.03550060051026

To the Editor.  —Dr Col and colleagues1 have proposed a partitioning diagram, based on the presence of risk factors for cardiovascular disease, breast cancer, and osteoporosis, to identify patients who would benefit from hormone replacement therapy (HRT). We recently conducted a survey evaluating the attitude of Belgian gynecologists concerning HRT initiation. We used hypothetical cases that were created with different risk levels of cardiovascular disease, osteoporosis, and breast cancer. A total of 4108 cases were analyzed.2 No cases with left ventricular hypertrophy, a systolic pressure of greater than 174 mm Hg, or more than 1 relative with breast cancer were included, but the other risk factors used by Col et al were present. The hip fracture risk was based on the T score obtained with the vertebral bone mineral measurement, using the definitions for low bone mass (T score, <-1) and osteoporosis (T score, <-2) as suggested by