Physician counseling on hormone replacement therapy and bone loss: do socioeconomic and racial characteristics of women influence counseling?

BACKGROUND

Although women consider multiple issues when deciding to take hormone replacement therapy (HRT), both women's use and physician counseling about HRT are strongly associated with sociodemographic factors. As prevention of bone loss is the best established long-term benefit of HRT, we sought to determine (1) if counseling about bone loss is included in discussions of HRT and (2) if sociodemographic factors affect the preventive content of HRT counseling.

METHODS

We evaluated reports of counseling on estrogen and bone loss from 1404 women aged 40-60 who reported any counseling on HRT in the 1994 National Health Interview Survey (NHIS). We also examined the association between these reports and sociodemographic factors, adjusting for clinical history, physician specialty, and physician visits.

RESULTS

We found that 80% of the women reported counseling on the effects of estrogen on bone loss. After adjustment, high school graduates (adjusted odds ratio [AOR] 1.68, confidence interval [CI] 1.02, 2.77) and college graduates (AOR 2.45, CI 1.33, 4.52) were much more likely to be counseled than women without a high school diploma. Black women were less likely to be counseled about bone loss (AOR 0.55, CI 0.33, 0.93). Although general health and menopausal symptoms were strongly associated with counseling on HRT and bone loss, neither of the osteoporosis risk factors of low body mass index (BMI) and smoking influenced counseling.

CONCLUSIONS

Most patients who discussed HRT with their providers discussed the effects of HRT on bone loss. For those who did not, several sociodemographic factors associated with any counseling on HRT are also associated with the content of HRT counseling. Understanding and addressing counseling inequities could reduce the effect of such factors on osteoporosis assessment and treatment.