A new study reveals that the bone fracture protection provided by menopausal hormone therapy (MHT, commonly called HRT) vanishes within a year of discontinuing treatment—and for most women, this is followed by years of elevated fracture risk compared to those who never used MHT.
Over time, the risk eventually aligns with, then drops below, that of never-users, according to research published in Lancet Healthy Longevity.
Led by experts from the University of Nottingham’s School of Medicine and funded by the National Institute for Health and Care Research (NIHR) SPCR, the study analyzed data from 6 million women across 2,000 UK GP surgeries, tracking fracture risk for up to 25 years.
Researchers compared women with first-time fractures (cases) to age-matched, fracture-free peers (controls), examining their MHT usage patterns.
Menopause brings a sharp decline in estrogen, triggering symptoms like hot flashes and accelerating age-related bone weakening. MHT, which replaces lost hormones, is known to reduce fracture risk during use.
However, long-term use is discouraged due to links to breast cancer and blood clots, making it critical to understand how its protective effects persist post-treatment—a gap previous short-term, conflicting studies failed to clarify.
The new findings confirm that MHT users have steadily lower fracture risk than non-users. But after stopping treatment, the protective effect fades entirely within a year.
For most women, fracture risk then rises above that of never-users, peaking around three years post-discontinuation. It takes about a decade for the risk to match never-users again, eventually falling even lower in later years.
This risk pattern holds across all MHT types, though the degree of excess risk varies by treatment type and duration of use, notes lead author Dr. Yana Vinogradova from the university’s Centre for Academic Primary Care.
“These insights can guide doctor-patient discussions about MHT options, helping anticipate high-risk periods,” Dr. Vinogradova explains. “Clinicians may want to check bone health at discontinuation, especially for patients with other risk factors like smoking or inactivity.” She adds that the findings could also spur further clinical and biological research into MHT.
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