Postmenopausal osteoporosis is a frequent clinical condition which affects nearly 1 in 3 women. Estrogen deficiency leads to rapid bone loss which is maximal within the first 2–3 years after the menopause transition and can be prevented by menopause hormone therapy (MHT). Not only, MHT prevents bone loss and the degradation of the bone microarchitecture but it significantly reduces the risk of fracture at all bone sites by 20–40%. It is the only anti-osteoporotic therapy that has a proven efficacy regardless of basal level of risk, even in low-risk women for fracture. Following the publication of the WHI results, use of MHT has considerably declined due to safety concerns which raise the question as to whether it might still be used in the prevention of osteoporosis. Over the last years, subsequent re-analyses of the WHI and further trials have challenged the initial conclusions of the WHI. It is now clearer that the individual benefit-risk balance of MHT is dependent on the individual risk profile in each woman as well as whether estrogen is opposed or unopposed, the type of estrogens and progestogens or doses and routes of administration. It must be also reminded that to date osteoporosis is a chronic disease that cannot be cured. The choice of the 1st treatment option should thus always be made in the context of a more comprehensive long-term strategy. This is particular true in early postmenopausal women found to be at low/moderate risk of fragility fracture over the first 10 years after menopause but who may have a much greater lifetime risk. In the absence of contraindication, use of MHT should be considered as a 1st option for the maintenance of bone health in those women where specific bone active medications are not warranted. Subsequent reassessment of the individual benefit-risk balance of MHT is thereafter recommended, with the possibility of switching to another osteoporosis treatment if the balance is not considered as favourable as at the beginning of the menopause for women still at high risk of fracture.

绝经后骨质疏松症是一种常见的临床疾病，影响近三分之一的女性。雌激素缺乏会导致快速的骨质流失，这在绝经过渡后的头 2-3 年内最为严重，可以通过更年期激素治疗 (MHT) 来预防。MHT 不仅可以防止骨质流失和骨微结构的退化，而且可以将所有骨骼部位的骨折风险显着降低 20-40%。它是唯一一种无论基础风险水平如何都被证明有效的抗骨质疏松疗法，即使在骨折风险低的女性中也是如此。在 WHI 结果公布后，由于安全问题，MHT 的使用已大大减少，这引发了关于它是否仍可用于预防骨质疏松症的问题。在过去的几年，随后对 WHI 的重新分析和进一步的试验对 WHI 的初步结论提出了挑战。现在更清楚的是，MHT 的个体利益-风险平衡取决于每个女性的个体风险状况以及雌激素是否被反对、雌激素和孕激素的类型或剂量和给药途径。还必须提醒的是，迄今为止，骨质疏松症是一种无法治愈的慢性疾病。因此，应始终在更全面的长期战略的背景下选择第一种治疗方案。在绝经后早期女性中尤其如此，她们被发现在绝经后的前 10 年中处于低/中度脆性骨折风险，但她们的终生风险可能要大得多。在没有禁忌症的情况下，对于不需要特定骨活性药物的女性，应将使用 MHT 作为维持骨骼健康的第一选择。此后，建议重新评估 MHT 的个体利益-风险平衡，如果认为平衡不如绝经开始时对仍然处于骨折高风险的女性有利，则有可能切换到另一种骨质疏松症治疗。