Menopausal Hormone Therapy Benefits Bone Health For Several Years After Discontinuation Interview with:

Dr Georgios Papadakis FMH, Médecin InternenMédecin assistant Service d'endocrinologie, diabétologie et métabolisme Lausanne

Dr Georgios Papadakis

Dr Georgios Papadakis
FMH, Médecin InternenMédecin assistant
Service d’endocrinologie, diabétologie et métabolisme
Lausanne What is the background for this study?

Response: This study was mainly motivated by the absence of available data on the effect of menopausal hormone therapy (MHT) on bone microarchitecture, as well as contradictory results of previous trials regarding the persistence of a residual effect after MHT withdrawal.

We performed a cross-sectional analysis of 1279 postmenopausal women aged 50-80 years participating in OsteoLaus cohort of Lausanne University Hospital. Participants had bone mineral density (BMD) measurement by dual X-ray absorptiometry (DXA) at lumbar spine, femoral neck and total hip, as well as assessment of trabecular bone score (TBS), a textural index that evaluates pixel grey-level variations in the lumbar spine DXA image, providing an indirect index of trabecular microarchitecture. What are the main findings?

• The demonstration for the first time that current menopausal hormone therapy use is associated with better preservation of bone microarchitecture, as indicated by higher TBS values compared to women who have never used or have stopped MHT
• Current users (CU) of MHT present with higher values of BMD at all sites compared with never users (NU). The benefit persists for past users (PU) compared with NU for BMD at lumbar spine and total hip.
• Both CU and PU show a significant slow-down of the age-associated decline in TBS as well as BMD at lumbar spine and total hip, when compared with NU.
• Contrary to BMD at lumbar spine, TBS seems to not be susceptible to falsely elevated values with age due to osteoarthritic changes
• The bone benefits of  menopausal hormone therapy do not depend on duration of treatment. However time since MHT discontinuation is an important factor in PU and the inflexion point beyond which the bone benefits in PU disappear is between 2 and 4 years post MHT withdrawal. What should readers take away from your report?

Response: The enhancement of bone microarchitecture contributes to the well-established anti-fracture effect of  menopausal hormone therapy, in addition to the well-known increase in BMD.

This finding should be taken into account when assessing treatment of postmenopausal women with deteriorated bone microarchitecture, as indicated by low TBS values. Responding at least partially to the pre-existing controversy, our study arguments against an excessive bone loss (rebound effect) after  menopausal hormone therapy withdrawal, given data showing persistence of an advantage on bone parameters for 2-4 years after cessation of treatment. These results can be useful for physicians addressing follow-up of women at risk for osteoporosis during MHT or after its withdrawal.

I think it is important to acknowledge that heterogeneity among individuals is highly likely and future research should try to better identify women who will maintain an important residual effect after MHT withdrawal versus those at risk for rapid bone loss. Many confounding factors can be speculated (BMI, vitamin D, BMD at time of MHT withdrawal). What recommendations do you have for future research as a result of this study?

Response:  A comparison between the effect of menopausal hormone therapy and other bone-acting treatments (bisphosphonates, denosumab, SERMs) on TBS seems also interesting in order to explore if preferential effects on bone microarchitecture are mediated by estrogen-based treatments Is there anything else you would like to add?

Response: Those results will be useful mainly for early post-menopausal women, particularly those 50-60 years old. MHT implementation in older women should be considered very cautiously given the increased risk of adverse events as shown in previous studies. Thank you for your contribution to the community.


Georgios Papadakis, Didier Hans, Elena Gonzalez-Rodriguez, Peter Vollenweider, Gérard Waeber, Pedro Manuel Marques-Vidal, Olivier Lamy. The Benefit of Menopausal Hormone Therapy on Bone Density and Microarchitecture Persists After its Withdrawal. The Journal of Clinical Endocrinology & Metabolism, 2016; jc.2016-2695 DOI: 10.1210/jc.2016-2695

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Last Updated on November 22, 2016 by Marie Benz MD FAAD