Osteoporosis & HRT (MHT)

If declining estrogen plays a role in osteoporosis and bone health, it would make sense to focus on boosting estrogen in the body. Let’s take a look at one of the ways to improve estrogen: HRT (Hormone Replacement Therapy), or as it’s referred to today: MHT (Menopause Hormone Therapy).

I will preface this post with I’m not a doctor. It’s always your choice. There are several options available and many specialists to speak with. Advocate for yourself, find a specialist who will listen to and work with you and your unique needs.

Rather than go through the pros and cons/ risks and benefits of MHT, I’m sticking to the information regarding bone health and osteoporosis. I encourage you to have the MHT discussion with your health care professional.

Osteoporosis and MHT

According to Osteoporosis Canada:

“Menopause Hormone Therapy (MHT) with estrogen and progesterone, is commonly used to relieve the symptoms of menopause. Because estrogen plays an important role in maintaining bone, MHT is another option to consider to treat osteoporosis if you are also seeking relief from symptoms of menopause.” 1

How it works:

‘Estrogen/progesterone treatment is not intended to “replace” the loss of these hormones, but to supplement these hormones to the lowest level required to prevent bone loss. Treatment can consist of estrogen alone (in women without a uterus) or estrogen and progesterone in combination.”

The important questions is:

How effective is MHT at improving osteoporosis and bone health?

Endocrinology Advisor reports that according to study results presented at ENDO 2026 in June :

“The study investigators concluded, “In this real-world cohort, menopausal hormone therapy was strongly and independently associated with higher bone mineral density and a substantially lower risk of low BMD. These findings suggest that, beyond symptom control, MHT may represent an underutilized strategy for bone preservation in appropriately selected postmenopausal women, particularly within the early postmenopausal window.”2

The study also noted that higher vitamin D levels were associated with a lower risk for low BMD (bone mineral density) and smoking was associated with higher risk of low BMD.

The Advisor reports:

“Nearly half of women (48.1%) had low BMD. MHT users vs nonusers had significantly higher BMD in the lumbar spine (mean T-score, -0.62 vs -1.02; P <.001) and total hip (mean T-score, -0.32 vs -0.81; P <.001).”

So, nearly half of the women studied had lower-than-normal bone density. Remember, with T-scores, the closer the number is to zero, the better the bone density. Those who were using menopausal hormone therapy had stronger bones in both the spine and hip than women who were not using hormone therapy. On average, their bone density remained closer to the normal range, and the difference between the two groups was unlikely to be due to chance.

And there it is again: that early postmenopausal window! I’m fascinated by that window as I’m sure you’ve noticed if you’re following this series.

What we don’t know are details like how much the women exercised, what type of exercise, other supplements taken, etc.

A 2023 article in the National Library of Medicine says:

“MHT can be considered as a means to protect bone health, especially if initiated before menopause or if accelerated bone loss is documented soon after menopause.”

Okay, let’s pause the research rabbit hole for a moment and discuss. I’ve stated in previous posts that I wish I’d known sooner how premature menopause would affect my bone health, but here’s the honest truth:

When my GYN suggested MHT for reasons unrelated to bone health, I was very hesitant to begin. It is a personal choice and I would have preferred herbal or lifestyle adjustments. What made me begin was the fact that I had tried many things. That I had a multitude of symptoms and needed to improve my health in a meaningful way to slow the landslide from washing away the last of my well-being.

I’m happy I made that choice. I was 7 years post-menopausal when I began MHT. Who knows just how bad my bone density numbers might have been if I’d chosen not to start the MHT. And who knows how good they may have been if I’d started earlier. We can’t go there. That will only increase mental suffering.

We are where we are. So we deal with where we are. And, quite frankly, if I’d not received the diagnosis of osteoporosis, I wouldn’t be blogging about it and spreading awareness.

We’ll make medicine from suffering and see if we can support others with the benefits.

Of course, MHT isn’t the only option. In later posts we will look at phytoestrogens for improving bone density.

What if estrogen therapy is not an option?

Speaking with a friend this morning, she mentioned how hormone therapy is not an option for her as she has beat breast cancer twice. So, what do women with osteopenia or osteoporosis do when hormone therapy is off the table?

If you are not a candidate for MHT, non-hormonal medication and nutrition and lifestyle adjustments (I can’t wait to get into those posts) will be your path forward to managing bone health.

One more consideration that we didn’t cover (I say we because I feel like you’re now on this exploration with me), is testosterone therapy for women.

What about Testosterone?

Testosterone is often thought of as a male hormone, but women produce testosterone too, and it plays important roles in the body. A study looking at middle-aged postmenopausal women found that women with higher blood testosterone levels tended to have higher bone mineral density in their lumbar spine (lower back). 3

The researchers found this relationship was seen up to testosterone levels of approximately 30 ng/dL, suggesting that women with very low testosterone levels may potentially benefit from addressing low levels as part of a broader approach to bone health.

Estrogen and Testosterone?

Another small study spanning 2 years compared estradiol alone against estradiol plus testosterone.

“BMD (DEXA) of total body, lumbar vertebrae (L1–L4) and hip area increased significantly in both treatment groups.” 4

That’s great news, but wait for it…

“BMD increased more rapidly in the testosterone treated group at all sites.”

The women receiving testosterone along with estrogen gained bone density faster than the women receiving estrogen alone.

Another benefit the researchers observed:

“Total body fat-free mass increased in the E&T group only.”

Fat-free mass generally means:

muscle
lean tissue
other non-fat tissues

So:

The women receiving testosterone gained more lean body mass compared with estrogen alone.

This is important because muscle and bone are deeply connected.

More muscle generally means:

potentially lower fall risk
more strength
more mechanical stimulation on bones
better balance

That feels like a mic-drop moment for MHT and bone health. I’m not saying this is the path. It’s not about what’s right… it’s about what’s right for you.

Testosterone therapy in women is a specialized conversation, and dosing, delivery methods, and monitoring matter. Talk to your doctor or a hormone specialist.

Of course, this study does not mean:

All women with osteoporosis should take testosterone…or estrogen.

It means:

Testosterone may play a role in bone health, muscle, and sexual wellbeing for some postmenopausal women, and it deserves thoughtful discussion as part of individualized care.

As always, this is one piece of a much larger picture. Bone health is influenced by many factors, including hormones, nutrition, movement, muscle strength, lifestyle, genetics, and overall health. And we’ll get to it all throughout this series.

So much to explore about bones! Thank you for joining me on this journey.

Much love,

Stephanie

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