Menopausal Hormone Therapy Associated with 69% Reduced Odds of Low Bone Mineral Density in Postmenopausal Women
Key Insights
A retrospective cohort study of 387 postmenopausal women found hormone therapy use was associated with 69% lower odds of low bone mineral density (OR = 0.31; 95% CI, 0.19-0.5).
Hormone therapy users had significantly higher BMD at the lumbar spine (T-score, −0.62 vs −1.02; P < .001) and total hip (T-score, −0.32 vs −0.81; P < .001) compared with nonusers.
The protective association remained consistent across multiple sensitivity analyses accounting for physical activity, calcium supplementation, hypertension, and chronic kidney disease.
CHICAGO — Use of menopausal hormone therapy (search) (MHT) was associated with a 69% reduction in the odds of low bone mineral density (BMD) among postmenopausal women, according to findings presented Sunday at ENDO 2026, the Endocrine Society's annual meeting. The real-world observational study adds to the body of evidence supporting the skeletal benefits of hormone therapy and may help reshape clinical conversations that have long been dominated by safety concerns.
"We undertook this study because menopausal hormone therapy (search) remains one of the most effective interventions for preserving bone mass after menopause, yet many eligible women continue to avoid treatment," said Diego Espinoza-Peralta, MD, MSc, endocrinologist at Investigación Médica Sonora (search) (INMEDS) in Hermosillo, Mexico, and vice president of the Mexican Society of Nutrition and Endocrinology (search) (SMNE), who presented the findings. "We wanted to evaluate whether the association between MHT and bone health observed in clinical trials could also be identified in a real-world clinical population."
Study Design and Population
Espinoza-Peralta and colleagues conducted a retrospective cohort study of 387 postmenopausal women who underwent dual-energy X-ray absorptiometry (DXA) scans between 2021 and 2025. Among the cohort, 33.3% were using menopausal hormone therapy (search), while the remaining 66.7% were nonusers. The two groups showed no significant differences in age, vitamin D levels, or years since menopause at baseline.
Low BMD was defined as osteopenia (search) or osteoporosis (search). Overall, 48.1% of the study population met this criterion.
Key Findings: BMD Differences and Risk Reduction
Compared with nonusers, women using MHT demonstrated significantly higher BMD at both anatomical sites measured. At the lumbar spine, MHT users had a mean T-score of −0.62 compared with −1.02 among nonusers (P < .001). At the total hip, users showed a mean T-score of −0.32 versus −0.81 in the nonuser group (P < .001).
After adjustment for age, years since menopause, body mass index, vitamin D levels, smoking status, and metabolic comorbidities, MHT use was associated with substantially reduced odds of low BMD (OR = 0.31; 95% CI, 0.19-0.50), corresponding to a 69% risk reduction.
"Importantly, the association remained essentially unchanged in multiple sensitivity analyses that included physical activity, calcium supplementation, hypertension, and chronic kidney disease," Espinoza-Peralta noted. "Because this was an observational study, the findings should be interpreted as an association rather than proof of causality. Nevertheless, the consistency across categorical outcomes, continuous DXA measurements, and multiple regression models strengthens confidence in the observed relationship."
Additional Risk Factors Identified
The analysis also revealed that increasing years since menopause (OR per year = 1.09; 95% CI, 1.02-1.16) and smoking (OR = 2.25; 95% CI, 1.01-5.02) were independently associated with elevated risk for low BMD. Conversely, higher vitamin D levels were associated with reduced risk (OR = 0.96; 95% CI, 0.93-0.99).
Biological Rationale and Clinical Implications
"Estrogen plays a central role in maintaining skeletal homeostasis," Espinoza-Peralta explained. "Following menopause, estrogen deficiency accelerates bone remodeling, resulting in increased bone resorption and progressive bone loss. MHT helps mitigate this process by reducing bone turnover and preserving bone mass."
He added that the skeletal benefits of estrogen therapy have been demonstrated in multiple randomized clinical trials and are reflected in current menopause management guidelines. "Our study was not designed to evaluate biological mechanisms, but our findings are consistent with the established physiological role of estrogen in bone health."
The researchers emphasized that these results should inform shared decision-making between clinicians and patients. "For many years, conversations regarding MHT often focused primarily on perceived risks," Espinoza-Peralta said. "Our results suggest that preservation of bone health remains an important benefit that should continue to be part of shared decision-making between clinicians and patients."
He further noted that the study "shifts the conversation from 'avoid if possible' to 'reconsider in the right patient,'" suggesting that clinicians may begin to weigh the benefits of hormone therapy more carefully, especially in women early after menopause, potentially improving long-term health and quality of life.
The study also addresses a notable gap in the literature, as there are relatively limited data from Latin American populations evaluating skeletal outcomes associated with MHT in routine endocrine practice.