IMPROVING COMPLIANCE WITH HORMONAL REPLACEMENT THERAPY IN PRIMARY OSTEOPOROSIS PREVENTION

Objectives: To evaluate whether introduction of treatment alternatives would improve compliance with hormonal replacement therapy (HRT) as p rimary osteoporosis prevention in women not tolerating the first line osteoporosis prevention schedule. Material and methods: Follow-up in f our hospitals participating in the Danish Osteoporosis Prevention Stud y. A total of 706 peri-and postmenopausal women aged 45-57 years betwe en 3 and 24 months from last menstrual bleeding took part, 489 women w ere randomised to HRT and 217 received HRT by personal choice. A total of. 135 (190/0) women were hysterectomised. HRT was given as oral or transdermal oestradiol supplemented with progestogen. If the initial t reatment allocation was not acceptable several alternatives were avail able in a pragmatic approach. Results: Compliance with first treatment schedule was lower in women with intact uterus (at 5 years: 48.3+/-2. 4% compliance) than in hysterectomised (64.7+/-5.8%, P<0.001 in a Cox analysis) but did not differ after the introduction of HRT alternative s (67.0+/-2.9 vs 77.8+/-5.9, P=0.12). Compliance decreased with increa sing age at treatment start (RR=1.11, P<0.001) in women with intact ut erus but not in hysterectomised women (P=0.96). Headache/migraine was more frequent among women with intact uterus on oral sequential oestro gen plus progestogen than among hysterectomised women receiving oral c ontinuous oestrogen (RR=11.3, P<0.01). Conclusions: It seems possible to maintain a high HRT compliance by a pragmatic approach including of fering alternative HRT formulations to women not tolerating the primar y HRT. Further research into long-term compliance with HRT and cost-be nefit is warranted. (C) 1997 Elsevier Science Ireland Ltd.