Menopausal Hormone Therapy Cuts Low Bone Density Risk by 69% in Real-World Study

Bone loss is one of the most consequential and underappreciated consequences of menopause, directly increasing the risk of fractures that can severely impair quality of life and independence in older women. New real-world evidence presented at ENDO 2026 adds meaningful weight to the case for menopausal hormone therapy as a bone-protective intervention.

In a retrospective cohort of 387 postmenopausal women who underwent DXA bone scans at an endocrine clinic between 2021 and 2025, low bone mineral density — encompassing both osteopenia and osteoporosis — occurred in just 31.8% of hormone therapy users versus 56.2% of non-users. After adjusting for hypertension, kidney disease, physical activity, and calcium supplementation, hormone therapy was associated with a 69% lower odds of low BMD. Results held stable across multiple sensitivity analyses.

Women on hormone therapy also posted significantly better T-scores at the lumbar spine and total hip, the two primary clinical sites used to assess fracture risk. These improvements are clinically meaningful — T-score differences of this magnitude translate to measurably lower fracture probability over time.

The findings arrive as the regulatory landscape around hormone therapy is shifting. The FDA recently removed long-standing boxed warnings from several hormone therapy labels — warnings that had chilled prescribing since the 2002 Women's Health Initiative trial. Despite this, only an estimated 2 million of 41 million eligible U.S. women received a hormone therapy prescription in 2020.

Clinical guidance remains nuanced. The Endocrine Society recommends hormone therapy for high-fracture-risk postmenopausal women but excludes those with breast cancer, prior heart attack or stroke, or women more than 10 years past menopause. Women considering this therapy should have a detailed, individualized risk-benefit conversation with their physician before initiating treatment.