Menopausal hormone therapy is recommended as second-line treatment for prevention of fractures for women with menopausal symptoms and there are no contraindications for menopausal hormone therapy.
The recommendation is strong because there is evidence of effect on fracture prevention, and because of large effect size on hot flushes and night sweats that may deteriorate sleep and working ability and strongly decrease quality of life.
A meta-analysis 1 included 28 studies with a total of 33426 participants and 2516 fractures cases. The overall relative risk with menopausal hormone therapy (HT) compared to placebo was 0.74 (95% CI, 0.69 to 0.80) for total fractures, 0.72 (95% CI 0.53 to 0.98) for hip fractures, and 0.63 (95% CI 0.44 to 0.91) for vertebral fractures. Estradiol led to greater decrease in the risk of total fractures compared with conjugated equine estrogens (P = .01). There was greater reduction in total fracture risk in trials of follow-up less than 36 months than that of follow-up more than 36 months (P = 0.003). No increase in the incidence of total cancer events but an increase in the incidence of thrombus was found to be associated with HT.
Primary/Secondary Keywords