Women who discontinue menopausal hormone replacement therapy (HRT) initially face a sharp increase in bone fracture risk, but over the long term, they experience reduced fracture risk compared to those who never used HRT. This is according to a recent study published in The Lancet, which provides new insights into the long-term effects of HRT on bone health.
Dr. Deborah Kwolek, a certified menopause specialist, commented on the findings, stating,
“It’s reassuring that long term, you didn’t seem to be worse off if you had taken hormones in the past. And it reconfirms that when you first go off the hormones, you’re going to lose some benefit, which can translate into higher fracture risk and that needs attention.”
Study Details and Outcomes
The research, led by Dr. Yana Vinogradova from the Centre for Academic Primary Care at the University of Nottingham, analyzed health records of 648,747 women aged 40 and older. These women were registered with a primary care practice between January 1, 1998, and February 28, 2023, and had a first record of any fracture. They were compared with 2,357,125 women of the same age and practice registration, who had no history of fractures.
The study utilized conditional logistic regression to assess menopausal HRT-related fracture risks, adjusting for demographics, family history, menopausal symptoms, comorbidities, and other medications. The research was extensive, covering all HRT prescriptions containing estrogen and progestogen as listed in the British National Formulary, and evaluated risk estimates up to 25 years post-therapy.
Reduced Fracture Risk in Older Age
The authors of the study highlighted that even after stopping HRT, women could benefit from a notably reduced fracture risk in older age.
“Our study suggests that, even after stopping menopausal hormone therapy, women could benefit from notably reduced fracture risk in older age,”
they wrote. This finding is significant, especially for women who may have used HRT for shorter durations due to concerns such as breast cancer.
These results contrast with previous studies, including the Women’s Health Initiative post-trial study, which did not find increased fracture risk after stopping hormone therapy.
Expert Opinions and Implications
Dr. Kwolek emphasized the importance of estrogen for bone health during the perimenopausal to menopausal transition. She noted that while the general understanding has been that the benefits of estrogen dissipate after discontinuation, the study suggests otherwise.
“We had been saying more recently that when women go off estrogen, there should be a plan for how their bone health may be addressed, potentially with medication and close monitoring,”
she said.
Dr. Kwolek also pointed out the importance of considering a patient’s baseline fracture risk. For younger, healthy women without osteoporosis, the increased risk may be negligible. However, for older women with existing osteoporosis, the effects could be more pronounced, necessitating alternative treatments to strengthen bones.
Addressing Women’s Bone Health
The findings underscore the need for greater attention to women’s bone health, particularly during menopause. Dr. Kwolek cautioned against viewing the temporary increase in fracture risk after stopping HRT as a deterrent to starting therapy. She highlighted the study’s strengths, including its large dataset and long follow-up period, as well as its focus on an often-overlooked area of women’s health care.
In primary care and gynecological settings, Dr. Kwolek noted,
“people aren’t paying as much attention to these transitions as I think they should.”
The study’s authors and Dr. Kwolek declared no relevant financial relationships, ensuring the integrity of the research.
Looking Forward
This study provides valuable insights into the long-term benefits of HRT on bone health, suggesting that women who have used HRT may enjoy reduced fracture risks well into older age. As healthcare providers consider these findings, they may need to develop comprehensive plans to manage bone health for women transitioning off HRT, ensuring that temporary increases in fracture risk are mitigated through appropriate interventions.
The implications of this research could lead to changes in how menopausal care is approached, with a stronger emphasis on personalized bone health strategies. As the medical community continues to explore the benefits and risks of HRT, studies like this one will be crucial in shaping future guidelines and improving patient outcomes.
