Hormone replacement therapy and the risk of osteoporosis

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Hormone replacement therapy and the risk of osteoporosis

Long-term hormone replacement therapy (HRT) reduces a woman's risk of developing osteoporosis, especially among women who have increased risk factors for osteoporosis. For more information, see the topic Osteoporosis.

After menopause, bones lose mass and density more rapidly than before menopause. Postmenopausal women are more likely to experience broken bones, such as hip fractures and compression fractures of the spinal bones. Women with osteoporosis lose height because of bone loss.¹

Osteoporosis is a common cause of bone fractures in older women, which can lead to chronic pain and disability. Fractures can affect:¹

• The bones of the spine (vertebrae).
• The hip. A hip fracture often leads to further health complications.
• The wrist.
• Tooth loss.

Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT):

• Reduce the risk of osteoporosis-related arm or hip fractures by about 30% to 50%.^{2, 3}
• Decrease the number of osteoporosis-related fractures by 50% when started soon after menopause.³
• Improve the absorption of calcium by the body to further prevent bone loss and related fractures. All women should include of calcium and 400 IU of vitamin D in their diet each day.¹

But HRT and ERT increase your risks of other adverse effects, including blood clots, ovarian cancer, and breast cancer.^{2, 4, 5}

Discuss your long-term risks of developing osteoporosis with your health professional. Other medications are available to prevent or treat osteoporosis related to menopause.

References

Citations

1. Speroff L, Fritz MA (2005). Menopause and the perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621–688. Philadelphia: Lippincott Williams and Wilkins.

2. Rossouw JE, et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3): 321–333.

3. Mishell DR (2001). Menopause. In MA Stenchever et al., eds., Comprehensive Gynecology, 4th ed., pp. 1217–1258. St. Louis: Mosby.

4. Women's Health Initiative Steering Committee (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA, 291(14): 1701–1712.

5. Beral V, et al. (2007). Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet, 369(9574): 1703–1710.

Credits

Last updated:	May 26, 2006
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Carla J. Herman, MD, MPH - Internal Medicine
Editors:	Kathleen M. Ariss, MS, Terrina Vail