Is Bone Health Something You Consider When Deciding About MHT? If Not, It Should Be.

A study presented at ENDO 2026 caught my eye because it puts a number on something we have known physiologically for years: estrogen protects bone, and declining estrogen in menopause speeds bone loss.

Researchers looked at 387 postmenopausal women who had a DXA scan. About a third were using hormone therapy. After adjusting for age, years since menopause, BMI, vitamin D, smoking and metabolic conditions, hormone therapy use was associated with 69% lower odds of low bone density (osteopenia or osteoporosis). Users also had better T-scores at both the lumbar spine and the total hip.

That hip number is the one I sit up for. Higher bone density at the hip generally tracks with lower hip fracture risk. A hip fracture is among the most life-altering injuries we treat. A better T-score there is not just a number on a report. It points toward fewer of the breaks we most want to prevent.

I want to be honest about what this is. It is an observational study, so it shows an association, not proof of cause. The selection of patients was small and from a single Latin American practice. The authors say so plainly, and I respect that.

Two other findings are worth flagging. More years since menopause and current smoking were tied to higher odds of low bone density, while higher vitamin D was protective. The familiar levers, again.

The decision to use hormone therapy should be a decision between you and your clinician. However, this study shows that bone protection deserves a real seat at the table when making these decisions, and should not just be an afterthought.

If you are weighing hormone therapy, ask where your bones fit into the plan. It is a fair question, and a DEXA scan and an informed provider can give it an honest answer.