In a recent publication in Menopause, researchers sought to assess the correlations of hormone therapy (HT) with lumbar spine BMD, osteopenia, and osteoporosis in postmenopausal women. The researchers also aimed to ascertain if these impacts continued after hormone preparations were terminated.
The authors indicated that the primary objective was to evaluate the associations of various hormone preparations with BMD, postmenopausal osteopenia, and postmenopausal osteoporosis.
They also wrote, “Given this controversial issue, our second objective was to explore the withdrawal effect of HT.”
The real-world study gathered data from 1999 to 2018 from the National Health and Nutrition Examination Survey and involved 6,031 postmenopausal women who were enrolled and divided into seven groups based on the types of hormone preparations. Additionally, among the participants, 1,996 women were further divided into a current users (CU) group and a past users (PU) group. To assess the correlations of hormone preparation with lumbar spine BMD, osteopenia, and osteoporosis, the researchers used multivariable linear regression models or logistic regression models. The researchers also explored the withdrawal effect of HT, and several therapies were investigated, including oral contraceptive pills, estrogen-only pills, estrogen/progestogen combination pills, and estrogen-only patches.
The results revealed that the use of combined oral contraceptive pills, estrogen-only pills, estrogen/progestin combination pills, estrogen-only patches, or the utilization of more than two kinds of hormone preparations were positively linked with lumbar spine BMD (all P <.05).
They also noted that except for estrogen-only patches, other hormone preparations also had a protective effect against osteopenia (all odds ratio [OR] <1, all P <.05), but none of the HT preparations were correlated with osteoporosis prevalence (all P >.05). The BMD augmented by 0.10 and 0.04 g/cm2 in the CU and PU groups, respectively, compared with the nonusers group (all P <.05). In both the CU and PU groups, the risk of osteopenia was diminished (OR 0.34 and 0.57, respectively).
Based on the results, researchers indicated that HT preparations augmented lumbar spine BMD in postmenopausal women and exerted a protective effect against osteopenia.
The authors also noted, “These impacts persisted after hormone preparations were discontinued. Hormone preparations, however, were not associated with osteoporosis prevalence.”
Based on their findings, the authors concluded, “Our study indicated that various hormone preparations increase lumbar spine BMD in postmenopausal women and have a protective effect against osteopenia, and these impacts persisted after HT was discontinued. Hormone preparations, however, were not associated with osteoporosis prevalence. Hormonal preparations altered the natural history of the three-stage decline in postmenopausal lumbar spine BMD to a linear decline, but the absolute value was greater.”
In a press release on the North American Menopause Society (NAMS) website, Stephanie Faubion, MD, NAMS medical director, stated, “This large cross-sectional study showed that current and prior use of multiple types of hormone therapies, including combined hormone contraception used in premenopausal women and menopause hormone therapies, were linked with bone protection in postmenopausal women and that these effects persisted after discontinuation of treatment. Additional study is needed to investigate the influence of time since stopping hormone therapy as well as the differential effects of various doses and formulations on bone health, including fracture risk.”
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Published May 17, 2023