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Review
. 2020 Dec;31(12):2271-2286.
doi: 10.1007/s00198-020-05497-8. Epub 2020 Jul 8.

Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?

S Rozenberg  1 , N Al-Daghri  2 , M Aubertin-Leheudre  3 , M-L Brandi  4   5 , A Cano  6 , P Collins  7   8 , C Cooper  9   10   11 , A R Genazzani  12 , T Hillard  13 , J A Kanis  14   15 , J-M Kaufman  16 , I Lambrinoudaki  17 , A Laslop  18 , E McCloskey  19 , S Palacios  20 , D Prieto-Alhambra  21 , J-Y Reginster  22   2 , R Rizzoli  23 , G Rosano  24 , F Trémollieres  25 , N C Harvey  26   27
Affiliations
Review

Is there a role for menopausal hormone therapy in the management of postmenopausal osteoporosis?

S Rozenberg et al. Osteoporos Int. 2020 Dec.

Abstract

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.

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Conflict of interest statement

N. Al-Daghri has no disclosures. M. Aubertin-Leheudre has no disclosures. M-L. Brandi reports honoraria from Amgen, Bruno Farmaceutici, Calcilytix and Kyowa Kirin; academic grants and/or speaker fees from Abiogen, Alexion, Amgen, Bruno Farmaceutici, Eli Lilly, Kyowa Kirin, MSD, NPS, Servier, Shire and SPA; and consultancy fees from Alexion, Bruno Farmaceutici, Kyowa Kirin, Servier and Shire outside the scope of the submitted work. A. Cano reports consultancy, honoraria and lecture fees from Theramex and Italfarmaco outside the scope of the submitted work. P. Collins reports consultancy, lecture fees and honoraria from Eli Lilly, Abbott, Novo Nordisk and Bayer outside the scope of the submitted work. C. Cooper reports consultancy, lecture fees and honoraria from AMGEN, GSK, Alliance for Better Bone Health, MSD, Eli Lilly, Pfizer, Novartis, Servier, Medtronic and Roche outside the scope of the submitted work. A. Genazzani has no disclosures. N. Harvey reports consultancy, lecture fees and honoraria from Alliance for Better Bone Health, AMGEN, MSD, Eli Lilly, Servier, Shire, UCB, Kyowa Kirin, Consilient Healthcare, Radius Health and Internis Pharma outside the scope of the submitted work. T. Hillard reports lecture fees and honoraria from Shionogi, Novo Nordisk and Theramex outside the scope of the submitted work. J. Kanis reports grants from UCB, grants from Amgen and grants from Radius Health outside the submitted work, and Dr. Kanis is a member of the National Osteoporosis Guideline Group (NOGG) and the principal architect of FRAX but derives no financial benefit. J-M. Kaufman is board member (treasurer) of ESCEO. I. Lambrinoudaki has no disclosures. A. Laslop has no disclosures. E. McCloskey reports consultant/advisor/speaker fees or research funding from Agnovos, Amgen, AstraZeneca, Consilient Healthcare, Fresenius Kabi, GSK, Hologic, I3 Innovus, Internis, Lilly, Merck, MRC, Novartis, Pfizer, Roche, Sanofi-Aventis, Servier, Synexus, UCB, Unilever, Versus Arthritis and Warner Chilcott outside the scope of the submitted work. S. Palacios has received consultancy, lecture fees, honoraria and grants from Serelys, Pfizer, Amgen, Gedeon Ritcher, Exeltis, Bayer Schering, MSD, Procare Health, Mylan and Shionogi outside the scope of the submitted work. D. Prieto-Alhambra’s research group reports research grants from Amgen, Servier and UCB; speaker tuition fees and advisory or consultancy fees (all paid to his department) from Amgen and UCB outside the scope of the submitted work. J-Y. Reginster reports consulting fees or paid advisory boards from IBSA-Genevrier, Mylan, Radius Health and Pierre Fabre; lecture fees when speaking at the invitation of sponsor from IBSA-Genevrier, Mylan, CNIEL and Dairy Research Council (DRC); and grant support from Industry (All through Institution) from IBSA-Genevrier, Mylan, CNIEL and Radius Health outside the scope of the submitted work. R. Rizzoli reports fees for advisory board or lectures from Abiogen, Amgen, CNIEL, Danone, Echolight, Effryx, EMF, Mithra, Mylan, Nestlé, ObsEva, Radius Health, Rejuvenate, Sandoz and Theramex outside the scope of the submitted work. G. Rosano has no disclosures. S. Rozenberg reports consultancy, lecture fees, honoraria and grants from Mylan, Abbott, Gedeon-Richter, UCB and Amgen outside the scope of the submitted work. F. Trémollieres reports lecture and/or consultancy fees from Amgen, Arrow, Lilly France and Theramex and non-financial support for meeting from Besins Healthcare France outside the scope of the submitted work.

Figures

Fig. 1
Fig. 1
Updated summary of the effects of orally administered CEE alone or combined with MPA in women ages 50–59 years during intervention phase of WHI (reused with permission from [9])
Fig. 2
Fig. 2
Treatment options at different levels of baseline fracture risk (reused with permission from [5]). Note that risk categories do not specifically correspond to age or menopause status. LOEP local osteo-enhancement procedure
See this image and copyright information in PMC

References

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