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.