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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 (

Original publication

DOI

10.1007/s00198-020-05497-8

Type

Journal article

Journal

Osteoporos int

Publication Date

12/2020

Volume

31

Pages

2271 - 2286

Keywords

Cardiovascular, Epidemiology, Hormone therapy, Menopause, Osteoporosis, Safety, Estrogen Replacement Therapy, Estrogens, Female, Hormone Replacement Therapy, Humans, Menopause, Middle Aged, Osteoporosis, Postmenopausal