While HRT has many benefits for those with osteoporosis, certain side effects may occur that your doctor will need to consider.

Osteoporosis is a common concern for people who have been through menopause. Hormone replacement therapy (HRT) is a common treatment for symptoms and complications associated with menopause, including osteoporosis.

HRT increases the level of estrogen in the body and can help prevent osteoporosis. Once osteoporosis develops, HRT can help prevent further bone loss and breakage.

Your body’s estrogen levels drop during menopause. One of estrogen’s functions in the body is keeping bones healthy. When your estrogen levels drop, it often leads to bone loss, fracture, and osteoporosis.

Estrogen-based HRT medications can replace estrogen levels and help prevent bone loss or the development of osteoporosis. They’re also a treatment option for people who already have osteoporosis because they can also help slow down bone loss and reduce the risk of fracture.

How is HRT prescribed?

There are two basic types of HRT used for osteoporsis: estrogen-only HRT and HRT, which include both estrogen and progesterone. HRT is available in a few different formulations. For instance, your doctor might prescribe a:

  • pill
  • skin patch
  • injection
  • gel
  • spray
  • liquid

The right form of HRT for your osteoporosis will depend on factors such as your health history, and the other medications you take, as well as on the other symptoms of menopause you’re experiencing.

Talk with your doctor or healthcare team if you’re interested in HRT treatments.

Side effects linked to HRT as an osteoporosis treatment can occur. Sometimes, changing your specific medication or medication dose can help eliminate side effects. It’s a good idea to mention any side effects you experience to your doctor.

Possible side effects include:

Some research also links HRT to an increased risk of a few conditions. Not all types of HRT carry the same risk. Also, many newer studies have contradicted the findings of older studies and found HRT safer than previously believed. It’s best to talk with your doctor about your personal risk level.

HRT has been linked to an increased risk of:

You can learn more about HRT for osteoporosis by reading the answers to some common questions.

HRT vs. bisphosphonates for osteoporosis treatment

Bisphosphonates are often the first line of treatment for osteoporosis, but they don’t work for everyone. HRT is thought to be as effective as bisphosphonates at reducing the risk of bone breakage for people with osteoporosis.

How long does it take for HRT to improve bone density?

The time it takes for HRT to increase bone density can vary depending on the individual. However, in one study, people who used HRT had an average increase in bone density of 3.7% after 5 years.

Can taking HRT prevent osteoporosis?

For some people, yes. Taking HRT can help reduce your risk of osteoporosis. It can keep your estrogen levels steady. This can build bone density and prevent bone loss and osteoporosis.

Does HRT affect osteoporosis for transgender people?

Osteoporosis is not a particular concern for HRT when used as a part of gender-affirming care. In fact, estrogen-based HRT can often improve the bone density in transwomen and AMAB individuals.

Testosterone-based HRT is not known to have a large effect on bone density in transmen and AFAB individuals. Transmasculine people may experience the onset of menopause as a part of testosterone-based HRT, which doctors may treat with other elements of HRT, such as topical estrogen.

Alternatives to HRT for osteoporosis treatment

Estrogen-based HRT isn’t the only available treatment for osteoporosis. In some cases, testosterone-based HRT can be an option. Your doctor might also suggest treatments such as:

  • Bisphosphonates: Bisphosphonates help prevent bone loss. They’re often a first-line treatment for osteoporosis and include medications such as Actonel and Fosamax.
  • Selective estrogen receptor modulators (SERMs): SERMs help manage how your body uses estrogen. They include medications such as Raloxifene.
  • Bone-building medications: Bone-building medications, such as Forteo and Evenity, can help increase bone density in people who’ve experienced fractures or who have very low bone density.
  • Biological medications: Biological medications can help slow down bone loss. They can be a good option for people who are unable to take bisphosphonates. They include medications such as denosumab and romosozumab.
  • Lifestyle changes: Lifestyle changes such as quitting smoking, limiting alcohol — if applicable to you — and increasing activity levels can help reduce bone loss.
  • Vitamins: It can be a good idea to ensure you’re getting enough vitamin D and calcium. You can do this through your diet or with the help of supplements.
Was this helpful?

Estrogen-based HRT is a treatment option for osteoporosis. It helps restore the estrogen levels that are necessary for bone density. Doctors may also use progesterone-based HRT in some situations.

HRT can help increase bone density and reduce the risk of fracture. Your doctor can help you determine whether HRT is a good treatment option for you.