But women who take MHT have a lower fracture risk in the long term compared to never-users, research suggests.
Stopping menopausal hormone therapy sharply increases the risk of fracture in the first few years afterwards, but the long-term fracture risk falls to lower levels than in women who never took MHT, researchers say.
The researchers used UK general practice and hospital data from almost 650,000 women aged 40 years and older with a history of at least one fracture and matched them with 2.3 million controls of the same age with no fracture history.
Among women who stopped taking MHT, the risk of fracture rose between one and 10 years afterwards,but then started dropping and became lower than that of never users for up to 25 years afterwards.
“Our study suggests that, even after stopping menopausal hormone therapy, women could benefit from notably reduced fracture risk in older age,” the UK researchers wrote in The Lancet Health Longevity.
The risk was the same for women who used MHT for shorter periods, such as those concerned about the risk of breast cancer, they said.
“Estimated extra fracture cases per 10000 women-years one-10 years after oestrogen–progestogen treatment were equivalent to 14 cases for less than five years menopausal hormone therapy exposure and five cases for five or more years of exposure,” the researchers said.
“However, for more than 10 years after discontinuation, we estimated three fewer fracture cases for those on oestrogen–progestogen therapy for less than five years exposure and 13 fewer fracture cases for those with 5 or more years of exposure.”
Australian sexual health physician Dr Terri Foran said the research reinforced the importance of helping patients increase their bone density when they stopped taking MHT.
This could be done through increasing vitamin D and calcium, doing exercise that stresses the bones, reducing alcohol and tobacco use, and discussing bone sparing medications, she said.
“It’s a finding that suggests that the effects of menopausal hormone therapy are not protective if you stop it, at least in the short term, and that we need to be talking about osteoporosis and fracture with all women who are getting older,” she told TMR.
“That time at which women stop menopausal hormone therapy is a really good time to do that.”
Dr Foran said women may not always tell their GP that they’ve decided to stop taking MHT.
“They often will talk about it and the best way to do it, but some women may not. But if that woman comes back and doesn’t require another prescription, that’s another chance to initiate a conversation about her bones,” she said.
“Talking to women about the possibility of having a baseline bone mineral density scan is important because that will give you an idea as to what their risks might be, because a lot of this is genetic. There are also other reasons why women might be at risk of osteoporosis – things like thyroid disease, use of steroids, early menopause.”
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Dr Foran said she recommended that her patients have a bone mineral density scan around menopause even if it wasn’t covered by Medicare.
“It’s a good investment – if a woman can afford it – around the time of menopause, because it gives us information about her bones,” she said
Professor Rodney Baber AM, clinical professor of obstetrics and gynaecology at The University of Sydney, said the drop in bone density shown in the study was not “alarming”, and the magnitude of the change in fracture risk was small.
He agreed that it was important to keep an eye on patients’ bone density when patients stop taking MHT.
“For women who are at higher risk of fracture it may be necessary to institute closer monitoring and perhaps some non-hormonal therapy during this phase,” he said.
Professor Baber said MHT had both anti-resorptive and anabolic effects on bone, and the study confirmed that MHT offered benefits during treatment and for up to 25 years after stopping treatment.
“Longer term use of MHT is associated with better bone health outcomes during treatment but also into old age,” he said.
The study gave further evidence of the benefit of MHT in improving bone health and reducing fracture risk in women in mid-life and beyond, he said.
“There is a short phase of one to 10 years where fracture risk may be increased although the estimated increase in absolute numbers is extremely low,” he said.
“After the initial post-stopping phase increase in fracture risk there is a return to a reduced fracture risk compared to controls who never, or briefly, used MHT.”
Professor Baber said the strengths of the study were its size, that it was powered to assess fracture risk in past users of MHT for up to 25 years after stopping, and the analyses by investigators.
