Prescription attitudes among gynecologists towards two particular risk factors of osteoporosis: the patient's age and her bone mineral density

Objective: The present report assesses, among Belgian gynecologists, the ef fect of age and bone mineral density on osteoporosis prescription strategy in postmenopausal women. Methods: Charts of postmenopausal women were summa rized. We constructed cases by modifying some parameters. Ten years of age were added or subtracted to the real age of the patient. The bone mineral d ensity ()BMD) result was a:lso modified (three levels: normal BMD, osteopen ia, osteoporosis). A total of 612 cases were constructed. Twelve cases were sent out of these 612 files to every Belgian gynecologist (n = 1010). For each chart the gynecologists were asked whether they would treat the patien t with HRT. They were also asked whether they would prescribe other therapi es than HRT and if so, which ones. Results: The chance to have an osteoporo sis prevention or treatment prescribed increased when BMD decreased (respec tively 57.4% for normal BMD, 73.1% for osteopenia cases and 89.4% for osteo porosis cases; P < 0.001). HRT was the most frequently prescribed medicatio n (67% of the cases), but its prescription rate does not reflect only osteo porosis prevention. Nevertheless, for similar cases with osteopenia, the HR T prescription rate increased by a factor 1.25 and for similar cases with o steoporosis, HRT prescription rate increased by a factor 1.39. Calcium was the 2nd most frequent prescribed regimen. It was prescribed in 17% of the c ases. A 3.4-fold increase for osteopenia cases and 7.6-fold increase for os teoporosis cases was observed, compared to women with normal BMD. When calc ium was prescribed, it was in association with HRT in 64% of the osteopenia cases and in 76% of osteoporosis cases. Other drugs were less often prescr ibed. For the <<younger age group>>, that is, with a mean age of 55 years, a prescription rate of 82.9% for any osteoporosis regimen was reached, wher eas in the age group that was 10 years older a 20% lower prescription rate was reached (62.6%, P < 0.001). This was mostly due to a decrease in HRT pr escription. Conclusions: Prescription of medication known to reduce osteopo rosis occurred more often in cases with low BMD. In the older patients with osteoporosis, gynecologists prescribed HRT less frequently. This was not c ompensated by a higher prescription rate of other medication. (C) 1999 Else vier Science ireland Ltd. All rights reserved.