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October 13, 1997

Randomized Trial of Osteoporosis Screening: Use of Hormone Replacement Therapy and Quality-of-Life Results

Author Affiliations

From the National Primary Care Research and Development Centre, Centre for Health Economics, University of York, York, England (Dr Torgerson), and the Health Services Research Unit (Mss Thomas and Campbell) and Department of Medicine and Therapeutics (Dr Reid), University of Aberdeen, Aberdeen, Scotland.

Arch Intern Med. 1997;157(18):2121-2125. doi:10.1001/archinte.1997.00440390121015

Background:  Screening perimenopausal women for low bone density has yet to be tested in a randomized trial. The effect of screening on the use of hormone replacement therapy (HRT) and the subsequent quality of life in these women is unknown. The purpose of this study was to assess the effect of a screening program on HRT use and quality of life.

Methods:  A random sample of women aged 45 to 54 years and living within 32 km of Aberdeen, Scotland, was selected from the community health index. Subjects were further randomized to screening or no screening using the design of Zelen. Two years after randomization, a questionnaire follow-up was mailed to both groups to assess HRT use and quality-of-life scores.

Results:  Use of HRT was higher in the screened group (30% vs 24%; difference, 6%; 95% confidence interval, 1%-11%; P=.02). A multivariate analysis indicated that the odds of using HRT for a screened woman whose measurement for bone mineral density was in the lowest quartile was 2.54 (95% confidence interval, 1.74-3.71) greater than that of an unscreened woman. Screening and subsequent HRT use did not have any detectable effects— positive or adverse—on women's quality of life.

Conclusion:  Screening for low bone density significantly increases the use of HRT in this population but without any immediate adverse or positive effects on quality of life.Arch Intern Med. 1997;157:2121-2125

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