Menopausal hormone therapy for fracture prevention: State of the art [Menopausale Hormontherapie zur Frakturprävention: Eine Standortbestimmung]

Menopausal hormone therapy, bone metabolism and fracture prevention: Based on the currently available data, menopausal hormone therapy (MHT) is an effective tool for preventing postmenopausal acceleration of bone metabolism and osteoporotic fractures. A sufficient calcium, vitamin D and protein dietary intake is a decisive factor for normal bone metabolism and successful fracture prevention and has to precede any hormonal or non-hormonal prevention of fragility fractures. Therapeutic importance of menopausal hormone therapy: Together with correct nutrition, adequate physical activity and the elimination of factors increasing the risk of falling, MHT occupies an important place in decreasing the fracture incidence in the perimenopause and early postmenopause. In postmenopausal women with increased fracture risk below the age of 60 years or within 10 years after menopause, MHT is one of the first line therapies for prevention and treatment of postmenopausal osteoporosis and fragility fractures. Every MHT should always be individualized. Personal and family history, the results of relevant investigations and the individual needs for fracture prevention have to be considered. In preventing fragility fractures, the benefits of MHT clearly outweigh the risks. As a rule, in the presence of premature ovarian insufficiency MHT should be started without delay and continued at least until the average age of natural menopause. Alternatively, tibolone and selective estrogen receptor modulators can be used depending on the indications, existing climacteric symptoms and the personal risk-benefit profile. In the later postmenopause and in the presence of manifest osteoporosis, a specific treatment with one of the established non-hormonal alternatives should be used. © 2015, Springer-Verlag Berlin Heidelberg.