Bone Mineral Densitometry Substantially Influences Health-Related Behaviors of Postmenopausal Women

Abstract

Although bone mineral density measurements are helpful in predicting future risk for osteoporotic fractures, there is limited information available on how the results of bone densitometry influence a woman's use of therapeutic alternatives. To assess the role of bone mineral densitometry in influencing postmenopausal women to change health behaviors associated with osteoporosis, we prospectively followed, for an average of 2.9 years, 701 postmenopausal women over 50 years of age referred to an osteoporosis prevention program in a large metropolitan area. Assessments included bone mineral densitometry by dual-energy X-ray absorptiometry (with classification of skeletal health), medical history, use of hormone replacement therapy, calcium intake, caffeine intake, exercise, smoking habits, and fall precaution measures. Women classified at baseline with moderate low bone mass were twice as likely (33%), and women with severe low bone mass more than three times as likely (47%) to start hormone replacement therapy compared with women with a normal result (13%, P < 0.001). This was true regardless of whether they had taken hormone replacement therapy in the past. Below-normal BMD was a strong predictor of a woman's initiation of hormone replacement therapy (OR 4.2; 95% CI 2.7-6.4; P < 0.05) even after adjustment for age, education, history of osteoporosis or fracture, and medical condition related to osteoporosis. Women with moderate or severe low bone mass were also much more likely to start calcium supplements (81-90% versus 67%), increase dietary calcium (71-82% versus 60%), decrease use of caffeine (44-60% versus 34%), start exercising (61-76% versus 52%), and quit smoking (22-24% versus 11%) relative to their behaviors prior to testing (P < 0.01). In conclusion, postmenopausal women report that the results of bone densitometry substantially influence the decision to begin hormone replacement therapy and calcium supplements, increase dietary calcium, decrease caffeine, increase exercise, decrease smoking, and take precautions to prevent falls. More studies are needed to measure the long-term effects of this influence.

Predictors of Change in Calcium Intake in Postmenopausal Women after Osteoporosis Screening ,

“…Age was not associated with women making a change in calcium intake after osteoporosis screening. Marci et al (13) also found that age, education, and history of osteoporosis, were not associated with starting calcium supplements. In addition, Rubin and Cummings (11) found that education was not associated with behavioral changes.…”

“…They found that women with below-normal BMD were 3 times as likely to start or increase calcium supplementation and increase their consumption of milk or calcium-rich food. Marci et al (13) found that BMD results were the most significant predictor of changes in calcium intake, and, in a recent study by Rohr et al (14), there was a significant increase in calcium-supplement intake in postmenopausal women with low BMD. Other studies report an increase in calcium intake after screening; however, these studies had a limited baseline evaluation and therefore no assessment of change (20)(21)(22), they did not use DXA the gold standard for BMD measurement (20,23), and they had a study population that included premenopausal women (20,22,12).…”

A Captive Audience: A Pilot Study of Screening and Counseling Hospitalized Women for Fracture Risk

“…This is consistent with the findings that initiation of estrogen is highest among women with lowest bone density. 18,19 We believe that the ultrasound with feedback of fracture risk was a critical part of this intervention, especially for individuals with lower BMD 20 because at baseline, there was low levels of concern and knowledge about osteoporosis. Low levels of understanding regarding osteoporosis has been shown previously.…”

Risk for Osteoporosis in Elderly Nuns: Need for Better Recognition and Treatment

“…The follow-up survey showed that 70% of respondents discussed the results with their physicians and that some women began taking calcium, multivitamins, vitamin D, or antiresorptive therapy. Related studies [47][48][49] have shown that women receiving central DXA measurements were more adherent with therapy and lifestyle changes than women who were not tested. The current work demonstrates that when the results of BMD screening are provided to the patient and/or physician, appropriate and potentially beneficial interventions can result.…”