Facilitating Patient-Specific Decisions Regarding Hormone Replacement Therapy

To the Editor.  —Dr Col and colleagues¹ have proposed a partitioning diagram, based on the presence of risk factors for cardiovascular disease, breast cancer, and osteoporosis, to identify patients who would benefit from hormone replacement therapy (HRT). We recently conducted a survey evaluating the attitude of Belgian gynecologists concerning HRT initiation. We used hypothetical cases that were created with different risk levels of cardiovascular disease, osteoporosis, and breast cancer. A total of 4108 cases were analyzed.² No cases with left ventricular hypertrophy, a systolic pressure of greater than 174 mm Hg, or more than 1 relative with breast cancer were included, but the other risk factors used by Col et al were present. The hip fracture risk was based on the T score obtained with the vertebral bone mineral measurement, using the definitions for low bone mass (T score, <-1) and osteoporosis (T score, <-2) as suggested by