Hormone replacement therapy and the risk of osteoporosis

Long-term hormone replacement therapy (HRT) reduces a woman's risk of developing osteoporosis, especially among women who have increased risk factors for osteoporosis. For more information, see the topic Osteoporosis.

After menopause, bones lose mass and density more rapidly than before menopause. Postmenopausal women are more likely to experience broken bones, such as hip fractures and compression fractures of the spinal bones. Women with osteoporosis lose height because of bone loss.1

Osteoporosis is a common cause of bone fractures in older women, which can lead to chronic pain and disability. Fractures can affect:1

  • The bones of the spine (vertebrae).
  • The hip. A hip fracture often leads to further health complications.
  • The wrist.

Estrogen replacement therapy (ERT) and hormone replacement therapy (HRT):

  • Reduce the risk of osteoporosis-related arm or hip fractures by about 30% to 50%.2
  • Improve the absorption of calcium by the body to further prevent bone loss and related fractures. The recommended daily calcium intake for adults ages 19 to 50 is 1,000 mg a day, increasing to 1,200 mg a day for adults older than 50. The recommended daily intake of vitamin D to help with calcium absorption is 400 to 800 IU for adults ages 19 to 50, and 800 to 1,000 IU a day for adults age 50 and older.

But HRT and ERT increase your risk of other adverse effects, including blood clots, ovarian cancer, and breast cancer.2, 3, 4

Discuss your long-term risk of osteoporosis with your doctor. Other medicines are available to prevent or treat osteoporosis related to menopause.


  1. Speroff L, Fritz MA (2005). Menopause and the perimenopausal transition. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 621–688. Philadelphia: Lippincott Williams and Wilkins.
  2. Rossouw JE, et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3): 321–333.
  3. Women's Health Initiative Steering Committee (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. JAMA, 291(14): 1701–1712.
  4. Beral V, et al. (2007). Ovarian cancer and hormone replacement therapy in the Million Women Study. Lancet, 369(9574): 1703–1710.

Last Updated: May 16, 2008

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