Menopausal hormone preparations increase lumbar spine bone mineral density

Key takeaways :

• All hormone preparations, except for estrogen-only patches, had a protective effect against osteopenia.
• None of the hormone preparations were associated with osteoporosis prevalence.

Among postmenopausal women, hormone preparations increased lumbar spine bone mineral density and had a protective effect against osteopenia, according to a real-world study published in Menopause.

“Our first objective was to evaluate the associations of various hormone preparations with bone mineral density, postmenopausal osteopenia and postmenopausal osteoporosis,” wrote Yiran Wang, MD, and Chao Sun, MD, both of the department of obstetrics and gynecology at The First Affiliated Hospital of Xi’an Jiaotong University in Shaanxi, China. “Given this controversial issue, our second objective was to explore the withdrawal effect of hormone therapy.”

In this real-world study, Wang, Sun and colleagues analyzed data from 6,031 postmenopausal women from the 1999 to 2018 National Health and Nutrition Examination Survey. Participants were divided into groups based on hormone preparation: 1,983 did not use hormone therapy; 614 used estrogen-only pills; 72 use estrogen/progestin combination pills; 23 used estrogen-only patches group; four used estrogen/progestin patches; 1,166 used two kinds of hormone preparation; and 224 used three or more kinds of hormone preparation. Of these, 1,996 participants were divided further into current users (n = 743) or past users (n = 1,253).

The researchers observed a positive association between lumbar spine bone mineral density (BMD) and use of combined oral contraceptive pills, estrogen-only pills, estrogen/progestin combination pills and estrogen-only patches; use of more than two kinds of hormone preparation was also associated with increased BMD (P < .05 for all). All hormone preparations — except estrogen-only patches — had a protective effect against osteopenia (P < .05 for all).

BMD increased by 0.1 g/cm² among current users and by 0.04 g/cm² among past users. Both current and past hormone preparation users had reduced risks for osteopenia with an OR of 0.34 for current users and 0.57 for past users, according to the researchers.

None of the hormone preparations were associated with osteoporosis prevalence.

“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 hormone therapy was discontinued,” Wang and Sun wrote. “Hormone preparations, however, were not associated with osteoporosis prevalence.”