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Review
. 2019 Dec;17(6):465-473.
doi: 10.1007/s11914-019-00549-3.

Update on Menopausal Hormone Therapy for Fracture Prevention

Jan J Stepan  1 , Hana Hruskova  2   3   4 , Miloslav Kverka  5   6
Affiliations
Review

Update on Menopausal Hormone Therapy for Fracture Prevention

Jan J Stepan et al. Curr Osteoporos Rep. 2019 Dec.

Abstract

Purpose of review: The goal of the review is to assess the appropriateness of menopausal hormone therapy (MHT) for the primary prevention of bone loss in women at elevated risk in the early years after menopause.

Recent findings: Estrogen alone or combined with progestin to protect the uterus from cancer significantly reduces the risk of osteoporosis-related fractures. MHT increases type 1 collagen production and osteoblast survival and maintains the equilibrium between bone resorption and bone formation by modulating osteoblast/osteocyte and T cell regulation of osteoclasts. Estrogens have positive effects on muscle and cartilage. Estrogen, but not antiresorptive therapies, can attenuate the inflammatory bone-microenvironment associated with estrogen deficiency. However, already on second year of administration, MHT is associated with excess breast cancer risk, increasing steadily with duration of use. MHT should be considered in women with premature estrogen deficiency and increased risk of bone loss and osteoporotic fractures. However, MHT use for the prevention of bone loss is hindered by increase in breast cancer risk even in women younger than 60 years old or who are within 10 years of menopause onset.

Keywords: Bone cells; Estrogens; Fracture; Postmenopausal osteoporosis; Prevention.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Jan Stepan reports grants from Ministry of Health of the Czech Republic, during the conduct of the study. Miloslav Kverka reports grants from Ministry of Health of the Czech Republic, during the conduct of the study.

Hana Hruskova declares no conflict of interest.

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