Hormone replacement therapy (in osteoporosis)

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

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.

Reference:

• 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