Osteoporosis is an increasing concern, with an estimated 180,000 osteoporosis related fractures in England and Wales each year, with around 85% of all osteoporotic fractures occurring in women.

With the knowledge that estrogen is beneficial for maintaining bone density and protective against osteoporosis, Hormone Replacement Therapy (HRT) was viewed as the Gold standard therapy for both preventing and treating osteoporosis in the menopause and postmenopause. However, with publication of initial results of the Women’s Health Initiative (WHI) Trial in 2002 which emphasised risks of HRT, risks which have since been shown to be unsubstantiated, the use of HRT for this purpose, and indeed use in general, declined significantly. Since then, there has been an increase in the use of bisphosphonates for treating osteoporosis but, particularly when used in younger women, concern has been expressed about the long term use of these drugs having an affect on bone structure such that unusual type fractures may occur at a later date. With such concerns in mind, and with publications of statements from several Menopause societies and the Endocrine Society reviewing the actual risks and benefits of HRT, the Royal Osteoporosis Society have now developed and published a Position Statement on the use of HRT in the prevention and treatment of osteoporosis.

The key recommendations are summarised as follows:

The decision to take HRT should be made after full discussion and consideration of risks and benefits, with regular review.

HRT is an effective treatment for menopausal symptoms and offers protection against fractures at both hips and spine. For women affected by osteoporosis aged under 60, HRT has a role to play in the management of osteoporosis.

Women who experience an early menopause, either natural or surgical, should be recommended HRT and advised to continue until at least the normal age of the menopause (51). This will reduce bone loss and control estrogen deficiency symptoms.

For postmenopausal women below the age of 60, who do not have risk factors for breast cancer, heart disease, stroke or blood clot (thrombosis), the risks associated with HRT are low and HRT can be considered as a treatment for osteoporosis.

Women up to the age of 60 who use HRT for relief of menopausal symptoms can be reassured that benefits of HRT will exceed risk, and the potential bone protective effect will be an additional benefit.

It is hoped that these recommendations will be widely accepted so that once again, HRT can be used appropriately to give women the bone protection that they require.

Ref Bowring CE, Francis RM. Royal Osteoporosis Society’s Position Statement on hormone replacement therapy in the prevention and treatment of osteoporosis. Menopause International 2011; 17: 63-65.