March 2015 Health Bulletin
Who should have a bone density?
This is what we have asked.
There are specific conditions that merit a bone density study (often called a DEXA study). These are supported by the Medicare Benefits Schedule (MBS) and include: prior low trauma fracture, age 70 years or more, use of glucocorticoid therapy (such as prednisolone) and conditions of increased glucocorticoid secretion, early ovarian or testicular failure, overactive thyroid, hyperparathyroidism, malabsorption, rheumatoid arthritis and chronic liver or renal disease. In general, however, there has been considerable uncertainty as to which women at midlife should have a bone density study.
So we investigated the characteristics of community-dwelling women referred for a screening DXA study (that is, women ineligible for a Medicare rebate) and found to have osteoporosis (T score < -2.5 on DEXA) that discriminate them from women not found to have osteoporosis 1.
Women aged between 40 and 65 years, referred to community-based radiology centres in several Australian states for a DXA study were invited to participate in our study. 1402 women, average age 58 years, completed study questionnaire and had DXA results available. 58% had an indication for a DEXA and the rest were having a ‘screening’ DEXA. 82% of the women sent for a screening DEXA were postmenopausal.
Our analysis revealed 3 main factors that were most strongly associated with osteoporosis: being postmenopausal, not taking hormone therapy and being underweight (body mass index below 18.5kg/m2). Normal weight women were at slightly greater risk than obese women. From this we developed the Monash Osteoporosis Risk Score for women at midlife, or MORS. This simple scoring system (MORS) that includes menopausal status, body mass index and current hormone therapy use, can enable doctors to identify the majority of women, aged 40 to 65 years, most likely to have osteoporosis prior to referral for a screening DXA scan, and potentially can eliminate 60% of DEXA screening studies.
 Davis SR, Tan A, Bell RJ. Targeted assessment of fracture risk in women at midlife. Osteoporos Int. 2015.
Does menopausal hormone therapy increase the risk of ovarian cancer?
A study published in the Lancet in February this year has raised concern that menopausal hormone therapy increases cancer risk. This concern is not new. The study reviews data from 52 past studies, some of which have previously suggested an association between hormone therapy and cancer risk. In essence this study suggests that for women who take hormone therapy there may be an extra 1-2 cases of ovarian cancer /10,000 women per year. We also know that for women who take hormone therapy there are approximately 51 less fractures / 10,000 women per year, and for those taking oestrogen with a progestogen in tablet form, possibly 9 extra breast cancers and 6 less bowel cancers / 10,000 women per year. We do not know whether the risk of breast cancer is the same for women using hormone patches. We do know that the risk of breast cancer does not appear to be increased for women taking oestrogen alone (women who have had a hysterectomy).
So a reasonable conclusion is that if there is an effect of hormone therapy on ovarian cancer risk, it is very small. Hormone therapy should primarily be used to relieve bothersome symptoms or to prevent bone loss. When a woman is weighing up the risk she should mostly focus on her the severity of her symptoms and her risk of breast cancer, fracture and heart disease.
More information about menopause can be found at HERE