MHT improves bone health in menopausal women

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Women who undergo menopausal hormone therapy can not only increase bone mass, but also improve bone structure, according to a Lausanne University Hospital study.

Previous studies have revealed the positive impact of menopausal hormone therapy (MHT) on bone mineral density. The new study is the first to show MHT also can improve bone mass and structure, and that the bone health benefits persist for at least two years after women stop treatment.

“When used in the right context, specifically in postmenopausal women younger than 60 years old for whom the benefits outweigh risks, menopausal hormonal therapy is effective for both the prevention and treatment of osteoporosis,” said the study’s first author, Dr Georgios Papadakis, of the Lausanne University Hospital in Lausanne, Switzerland.

Osteoporosis is a progressive condition in which bones become structurally weak and are more likely to fracture or break. Menopause, which usually occurs when a woman is in her 40s or 50s, significantly speeds bone loss. Over time, the human body is constantly breaking down and building new bone tissue. The imbalance between bone breakdown and formation causes bone mass to decrease, so osteoporosis can develop and fractures can occur more easily.

The cross-sectional study is based on data from the OsteoLaus cohort. The cohort consisted of 1,279 women ages 50 to 80 residing in the city of Lausanne, Switzerland. The participants were divided into three categories: 22% were undergoing MHT during the study, 30% were past users and 48% of women had never used MHT.

To measure whether MHT influenced bone health, researchers used dual x-ray absorptiometry (DXA) scans of the participants’ lumbar spine, femoral neck and hip to assess bone mineral density. Based on the scan results, the women were assigned a Trabecular Bone Score assessing the quality of their underlying bone structure. This score can be used to predict fracture risk in postmenopausal women.

Age and body mass index were major factors used in the study. Other variables included the history of fractures in participants, and the use of supplements such as current or past use of calcium and/or vitamin D. Blood test results for vitamin D levels from 1,204 out of the 1,279 participants were also factored into the study.

The researchers found higher Trabecular Bone Scores in current MHT users compared to past users or women who had never used MHT. All bone mass density values were significantly higher in current users compared to past users or participants who had never used MHT. Past users of the therapy exhibited higher bone mass density and a trend for higher bone micro-architecture values compared to women who had never used MHT. The researchers note that the duration of MHT had no effect on bone health.

“Women at menopause should take note of this study, because its results can help optimiSe the use of menopausal hormone treatment in women at risk of osteoporosis,” Papadakis said.

Abstract
Context: Menopausal hormone therapy (MHT) favorably affects bone mineral density (BMD). Whether MHT also affects bone microarchitecture, as assessed by trabecular bone score (TBS), has never been evaluated.
Objective: Our objective was to assess the effect of MHT on TBS and BMD before and after its withdrawal.
Design: This was a cross-sectional study.
Setting: This study included the general community.
Patients or other participants: Data were collected from the OsteoLaus cohort (1500 women aged 50–80 years). After exclusion of women with bone-modulating treatments, 1279 women were categorized according to MHT status into current (CU), past (PU), and never (NU) users.
Main outcome measure(s): Spine TBS and BMD at lumbar spine, femoral neck, and total hip were assessed by dual X-ray absorptiometry.
Results: Age- and body mass index-adjusted analysis showed higher TBS values in CU vs PU or NU (1.31 ± 0.01, 1.29 ± 0.01, and 1.27 ± 0.01, respectively; P < .001). All BMD values were significantly higher in CU vs PU or NU. Compared to NU, PU exhibited higher lumbar spine (0.94 ± 0.01 vs 0.91 ± 0.01 g/cm2; P = .017) and total hip (0.86 ± 0.01 vs 0.84 ± 0.01 g/cm2; P = .026) BMD and a trend for higher TBS (P = .066). The 10-year loss of TBS and BMD at lumbar spine and total hip was significantly lower for both CU and PU vs NU. MHT duration had no effect on bone parameters. In PU, the residual effect on TBS and BMD was significantly more prominent in early discontinuers ( Conclusion: MHT is associated with bone microarchitecture preservation, as assessed by TBS. The effect of MHT on TBS and BMD persists at least 2 years after withdrawal.

Authors
Georgios Papadakis, Didier Hans, Elena Gonzalez-Rodriguez, Peter Vollenweider, Gérard Waeber, Pedro Manuel Marques-Vidal, Olivier Lamy

Endocrine Society material
Journal of Clinical Endocrinology & Metabolism abstract


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