This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Hormone replacement therapy (in osteoporosis)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Oteoporosis and HRT

  • the baseline population risk of fragility fracture for women around menopausal age in the UK is low and varies from one woman to another

Risk of fragility fracture is decreased while taking HRT and that this benefit (1):

  • is maintained during treatment but decreases once treatment stops
  • may continue for longer in women who take HRT for longer.

Table: Absolute rates of any fragility fracture for HRT compared with no HRT (or placebo), different durations of HRT use and time since stopping HRT for menopausal women


Current HRT users

Treatment duration <5 years

Treatment duration 5-10 years

>5 years since stopping treatment

Women on any HRT

RCT estimate

23 fewer (-10 to -33)

25 fewer (-9 to -37)

No available data

No available data

Women on any HRT

Observational estimate

16 fewer (-15 to -18)

15 fewer (-11 to -17)

18 fewer (-15 to -20)

2 more (-19 to 27)

A Cochrane review which included data from 19 trials (n=42,830) investigated the long-term effect of HRT on multiple outcomes, including the incidence of hip fractures, clinically diagnosed vertebral fractures and total clinically diagnosed fractures. The majority of the evidence was derived from two large RCTs conducted by the WHI. The fracture-related data were considered as outcomes of secondary harm, therefore no power calculations were provided (2).

SIGN suggest:

  • hormone replacement therapy may be considered for the prevention of vertebral, nonvertebral and hip fractures in younger postmenopausal women
  • before initiating HRT healthcare professionals should assess every woman’s overall risk, including cardiovascular risk, particularly in those aged over 60 who have increased baseline risk of serious adverse events
  • for all women, the lowest effective dose of HRT should be used for the shortest time.


  • NICE (November 2015). Menopause: diagnosis and management
  • Marjoribanks J, Farquhar C, Roberts H, Lethaby A. Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database of Systematic Reviews 2012, Issue 7.
  • SIGN (June 2020). Management of osteoporosis and the prevention of fragility fractures

Related pages

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.