Menopausal Hormone Therapy Improves Bone Health

Women who undergo hormone therapy for menopausal symptoms such as hot flashes may be able to increase bone mass and improve bone structure, according to a new study published in The Journal of Clinical Endocrinology & Metabolism.

Researchers led by Georgios Papadakis, MD, of the Lausanne University Hospital in Lausanne, Switzerland point out that menopausal hormone therapy (MHT) “was for many years a first-line therapy in the prevention of postmenopausal osteoporosis a practice supported by observational data’’. However, there was some controversy over studies showing that the bone benefits of this treatment may be outweighed by  other adverse events, such as an increase in breast cancer, coronary heart disease, and stroke. According to the authors, further studies showed promising evidence for reduced risk of adverse events in younger postmenopausal women, as well as for sustained protection against bone loss even in lower doses, which also lowered the other risks. “As a result,” they write, “the latest guidelines reestablish MHT as a first-line treatment for the prevention of fracture in at risk women before age of 60 years or within 10 years after menopause without any mandatory time limit for the duration of treatment.”

This new study is the first to show MHT can improve bone and structure in addition to bone mass, and that the bone health benefits persist for at least two years after women stop treatment. “When used in the right context, specifically in postmenopausal women younger than 60 years old for whom the benefits outweigh risks, menopausal hormonal therapy is effective for both the prevention and treatment of osteoporosis,” says Papadakis.

“When used in the right context, specifically in postmenopausal women younger than 60 years old for whom the benefits outweigh risks, menopausal hormonal therapy is effective for both the prevention and treatment of osteoporosis.”

The cross-sectional study is based on data from the OsteoLaus cohort. The cohort consisted of 1,279 women aged 50 to 80 residing in the city of Lausanne, Switzerland. The participants were divided into three categories: 22% were undergoing MHT during the study, 30% were past users and 48% of women had never used MHT. To measure whether MHT influenced bone health, researchers used dual x-ray absorptiometry (DXA) scans of the participants’ lumbar spine, femoral neck and hip to assess bone mineral density. Based on the lumbar scan image and a well-validated software, Trabecular Bone Score was calculated for each women, an indice assessing the quality of the underlying bone structure.

Age and body mass index were major factors modifying  the results of the study. Other variables assessed included the history of fractures in participants, and the use of supplements such as current or past use of calcium and/or vitamin D. Blood test results for vitamin D levels from 1,204 out of the 1,279 participants were also factored into the study.

The researchers found higher Trabecular Bone Scores in current MHT users compared to past users or women who had never used MHT. All bone mass density values were significantly higher in current users compared to past users or participants who had never used MHT. Past users of the therapy exhibited higher bone mass density and a trend for higher bone microarchitecture values compared to women who had never used MHT. The researchers note that the duration of MHT had no effect on bone health. However, in past users the time since MHT discontinuation seems to be a crucial factor and the protective effects disappear 2-4 years after treatment withdrawal

“Women at menopause should take note of this study, because its results can help optimize the use of menopausal hormone treatment in women at risk of osteoporosis,” Papadakis says.

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