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Is there a role for menopausal hormone therapy in the management of post-menopausal osteoporosis?

Is there a role for menopausal hormone therapy in the management of post-menopausal osteoporosis?
Is there a role for menopausal hormone therapy in the management of post-menopausal osteoporosis?
We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.
0937-941X
2271–2286
Rozenberg, Serge
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Al-Daghri, Nasser M.
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Aubertin-Leheudre, Mylène
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Brandi, Maria Luisa
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Cano, Antonio
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Collins, Peter
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Cooper, Cyrus
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Genazzani, Andrea
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Hillard, Timothy C.
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Kanis, John A.
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Kaufman, Jean-Marc
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Lambrinoudaki, Irene
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Laslop, Andrea
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McCloskey, Eugene
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Palacios, Santiago
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Prieto-Alhambra, Daniel
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Reginster, Jean-Yves
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Rizzoli, Rene
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Rosano, Giuseppe
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Trémollieres, Florence
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Harvey, Nicholas
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Rozenberg, Serge
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Al-Daghri, Nasser M.
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Aubertin-Leheudre, Mylène
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Brandi, Maria Luisa
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Cano, Antonio
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Collins, Peter
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Cooper, Cyrus
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Genazzani, Andrea
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Hillard, Timothy C.
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Kanis, John A.
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Kaufman, Jean-Marc
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Lambrinoudaki, Irene
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Laslop, Andrea
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McCloskey, Eugene
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Palacios, Santiago
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Prieto-Alhambra, Daniel
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Reginster, Jean-Yves
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Rizzoli, Rene
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Rosano, Giuseppe
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Trémollieres, Florence
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Harvey, Nicholas
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Rozenberg, Serge, Al-Daghri, Nasser M., Aubertin-Leheudre, Mylène, Brandi, Maria Luisa, Cano, Antonio, Collins, Peter, Cooper, Cyrus, Genazzani, Andrea, Hillard, Timothy C., Kanis, John A., Kaufman, Jean-Marc, Lambrinoudaki, Irene, Laslop, Andrea, McCloskey, Eugene, Palacios, Santiago, Prieto-Alhambra, Daniel, Reginster, Jean-Yves, Rizzoli, Rene, Rosano, Giuseppe, Trémollieres, Florence and Harvey, Nicholas (2020) Is there a role for menopausal hormone therapy in the management of post-menopausal osteoporosis? Osteoporosis International, 31, 2271–2286. (doi:10.1007/s00198-020-05497-8).

Record type: Article

Abstract

We provide an evidence base and guidance for the use of menopausal hormone therapy (MHT) for the maintenance of skeletal health and prevention of future fractures in recently menopausal women. Despite controversy over associated side effects, which has limited its use in recent decades, the potential role for MHT soon after menopause in the management of postmenopausal osteoporosis is increasingly recognized. We present a narrative review of the benefits versus risks of using MHT in the management of postmenopausal osteoporosis. Current literature suggests robust anti-fracture efficacy of MHT in patients unselected for low BMD, regardless of concomitant use with progestogens, but with limited evidence of persisting skeletal benefits following cessation of therapy. Side effects include cardiovascular events, thromboembolic disease, stroke and breast cancer, but the benefit-risk profile differs according to the use of opposed versus unopposed oestrogens, type of oestrogen/progestogen, dose and route of delivery and, for cardiovascular events, timing of MHT use. Overall, the benefit-risk profile supports MHT treatment in women who have recently (< 10 years) become menopausal, who have menopausal symptoms and who are less than 60 years old, with a low baseline risk for adverse events. MHT should be considered as an option for the maintenance of skeletal health in women, specifically as an additional benefit in the context of treatment of menopausal symptoms, when commenced at the menopause, or shortly thereafter, in the context of a personalized benefit-risk evaluation.

Text
nch MHT review 2020_04_27R1 final clean - Accepted Manuscript
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Accepted/In Press date: 4 May 2020
e-pub ahead of print date: 8 July 2020

Identifiers

Local EPrints ID: 440979
URI: http://eprints.soton.ac.uk/id/eprint/440979
ISSN: 0937-941X
PURE UUID: 3c26b0e3-ddb5-45c9-ab47-7b0230dfc000
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

Catalogue record

Date deposited: 26 May 2020 16:32
Last modified: 26 Nov 2021 02:48

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Contributors

Author: Serge Rozenberg
Author: Nasser M. Al-Daghri
Author: Mylène Aubertin-Leheudre
Author: Maria Luisa Brandi
Author: Antonio Cano
Author: Peter Collins
Author: Cyrus Cooper ORCID iD
Author: Andrea Genazzani
Author: Timothy C. Hillard
Author: John A. Kanis
Author: Jean-Marc Kaufman
Author: Irene Lambrinoudaki
Author: Andrea Laslop
Author: Eugene McCloskey
Author: Santiago Palacios
Author: Daniel Prieto-Alhambra
Author: Jean-Yves Reginster
Author: Rene Rizzoli
Author: Giuseppe Rosano
Author: Florence Trémollieres
Author: Nicholas Harvey ORCID iD

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