Twenty to thirty years ago, HRT was seen as the gold standard for both prevention and treatment of osteoporosis. Then, with publication of trials emphasising the risks of HRT and not balancing risks against the known benefits, it was less often considered as playing an important part in osteoporosis prevention or treatment, despite its proven significant benefits. In recent times however, the balance has swung back to recognising its importance in bone health, with a review published in Osteoporosis International confirming that HRT (referred to as MHT—Menopausal Hormone therapy) should be considered for maintaining bone health in women, in view of the robust data showing reduced fracture risk.
It seems that the tide has turned and that women can be confidently offered HRT not only for control of menopausal symptoms, but also for maintaining bone health and reducing risk of fracture. With one in two women now predicted to suffer from an osteoporotic fracture, it is essential that women are aware of the importance of bone health and of options that can help.We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.
Keywords: Cardiovascular, Epidemiology, Hormone therapy, Menopause, Osteoporosis, Safety
Reference Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?