Archives of Osteoporosis · Oct 27, 2026

Revisiting menopausal hormone therapy for bone health: evidence, controversies, and clinical positioning in India in 2026

By Vaghasia N, Nagendra L, Kapoor N et al.

Menopause is characterized by the rapid decline of estrogen exposure, resulting in accelerated bone loss superimposed on the gradual age-related decline in bone mass. This process is particularly relevant in India, where women experience menopause earlier than Western populations, thereby increasing lifetime fracture risk. Menopausal hormone therapy (MHT) has been evaluated extensively over the years for skeletal health, with consistent evidence demonstrating preservation of bone mineral density and reduction in vertebral and hip fractures, especially when initiated early after menopause. Although multiple concerns arose following the Women's Health Initiative in terms of cardiovascular safety and breast cancer risk, leading to a decline in MHT use, subsequent analyses have supported a more favorable benefit-risk profile in appropriately selected younger postmenopausal women. Current evidence suggests that individualized MHT can also improve skeletal outcomes while benefiting menopausal symptoms and overall quality of life. This review revisits the evolving role of MHT in bone health in the Indian context.

doi.org/10.1007/s11657-026-01792-9PubMed 42946919Interventions