Menopausal hormone therapy (MHT) is effective in preventing menopause-related bone loss and decreasing vertebral, non-vertebral and hip fracture risk. MHT contains estrogens that exert both antiosteoclastic and osteoanabolic effects. These effects are dose-dependent, as even ultra-low doses preserve or increase bone mineral density. The transdermal route of administration is effective on cancellous and cortical bone, although fracture data are still lacking. Hormone replacement therapy is the treatment of choice to preserve skeletal health in women with premature ovarian insufficiency and early menopause. MHT can be considered in women aged < 60 years or within 10 years since menopause as, in this population, benefits outweigh possible risks, such as breast cancer and cardiovascular events. Despite the ensuing bone loss after MHT discontinuation, a residual antifracture effect persists. However, in women at risk of fracture, subsequent antiosteoporotic therapy may be needed, either with an antiosteoclastic or osteoanabolic agent. In any case, longitudinal data from randomized controlled trials comparing different estrogen doses and routes of administration, as well as designating the optimal treatment strategy after MHT discontinuation, are needed to elucidate these issues further.

更年期激素疗法 (MHT) 可有效预防与更年期相关的骨质流失并降低椎体、非椎体和髋部骨折风险。MHT 含有雌激素，可发挥抗破骨细胞和骨合成代谢作用。这些影响是剂量依赖性的，因为即使是超低剂量也能保持或增加骨矿物质密度。经皮给药途径对松质骨和皮质骨有效，但仍缺乏骨折数据。激素替代疗法是卵巢功能不全和更年期提前的女性保持骨骼健康的首选治疗方法。对于<60 岁或绝经后 10 年内的女性，可以考虑 MHT，因为在该人群中，其益处大于可能的风险，例如乳腺癌和心血管事件。尽管 MHT 停药后骨质流失，但残留的抗骨折效果仍然存在。然而，对于有骨折风险的女性，可能需要随后的抗骨质疏松治疗，使用抗破骨剂或骨合成药物。无论如何，需要来自比较不同雌激素剂量和给药途径的随机对照试验的纵向数据，以及指定停用 MHT 后的最佳治疗策略，以进一步阐明这些问题。