HRT Bone Fracture Risk: What You Need to Know

Youre on HRT. Maybe for the hot flashes, the night sweats, the sleepless nights that finally quieted down. And its working. You feel more like yourself again.

But lately, youve been wondering Should I stop?

Maybe your doctor mentioned it. Maybe youve heard whispers about long-term use. Or maybe you just want to take fewer medications as you move into this new chapter.

Heres what I want you to knowsomething that doesnt get talked about nearly enough: HRT doesnt just ease symptoms. It protects your bones.

And when you stop? That protection doesnt stick around forever.

In fact, research shows that your risk of bone fractures can risenot right away, but about a year or two after stopping. For up to three years, some women actually face a higher risk than those who never took HRT at all.

Waitwhat?

Yeah, I was surprised too. But this isnt speculation. Its from a massive UK study tracking nearly 6 million women. And it changes everything we thought about stopping HRT "cold turkey."

The good news? Youre not powerless. You can plan for this. Protect your bones. Make a smart, informed choicewithout fear, but with clarity.

Lets walk through this together.

Why Bones Matter

Lets be realbefore menopause, how often did you think about your bones?

Probably never. They just worked. You walked, danced, lifted groceries. Bones were background players.

But menopause changes the game.

When estrogen drops, your bones start losing densityfast. Think of it like a slow leak in a tire. You dont notice it at first. But over time? It adds up.

Thats where HRT comes in. Its not just about sleep and mood (though thats huge). Its also one of the most effective ways to slow bone loss in the early years after menopause.

How? Estrogen helps keep bone-resorbing cells called osteoclasts in check. Without estrogen, these cells go into overdrivebreaking down bone faster than your body can rebuild it.

HRT steps in and says, "Hey, slow down." It doesnt build bone like some osteoporosis drugs, but it does prevent it from vanishing too quickly.

And that makes a real difference in your risk of fractures.

What Science Says

Youve probably heard of the Womens Health Initiative (WHI)one of the largest and most respected studies on menopause and HRT. And when they looked at fracture risk?

The results were clear.

In over 25,000 women studied, HRT reduced:

• Any clinical fracture by 28%
• Hip fractures by 34%
• Major osteoporotic fractures by 40%

And get thisit didnt matter if a woman was at low or high risk to begin with. HRT helped across the board.

Thats rare in medicine. Most osteoporosis drugs work better in high-risk women. But HRT? Its like a safety net for everyone, especially in those early menopause years.

Its even more impressive when you consider that these benefits were seen in women who started HRT close to menopausewithin that "sweet spot" of under 60 or within 10 years of their last period.

So if you started HRT during that window, you werent just feeling betteryou were building long-term bone resilience.

The Hidden Risk

Now, lets talk about what happens when you stop.

You might assume the benefits just fade gently. Or maybe they linger. After all, you did the right thing for years.

But a groundbreaking 2025 study from the University of Nottingham says otherwise.

Tracking up to 25 years after women stopped HRT, researchers found something unexpected: a "rebound effect."

Time After Stopping HRT	Bone Fracture Risk
01 year	Protection begins to fade
13 years	Risk rises above women who never used HRT (peaks around year 3)
~10 years after stopping	Risk levels out to match never-users
Beyond 10 years	Risk may fall below never-users

Yes, you read that right. For a few years after stopping, your risk goes up compared to women who never took HRT.

Dr. Yana Vinogradova, the lead researcher, put it plainly: "The bone protective effect of MHT disappears within about one year of stopping and fracture risk rises compared to never-users, peaking after about three years." according to the University of Nottingham study.

Why does this happen?

We dont know for sure, but one theory is that your bones got used to the steady protection of estrogen. When its suddenly gone, the body reactsalmost like its playing catch-up in the worst way. Bone loss accelerates. And if you fall? Your bones may not handle it as well.

The takeaway? Stopping HRT isnt a neutral event. Its a transitionone that your bones notice.

Whos at Risk?

Not everyone faces the same level of risk after stopping HRT. Some women breeze through with no issues. Others need more support.

So what makes the difference?

Here are the big onesfactors that can increase your fracture risk when stopping HRT:

Factor	Increases Risk?	Why
Early menopause (<45)	Yes	Longer time without estrogen = faster bone loss
Family history of osteoporosis	Yes	Genetic predisposition to weak bones
Low BMI or small frame	Yes	Less bone mass to lose
Smoking	Yes	Reduces blood flow to bones; lowers estrogen
Inactivity	Yes	Weight-bearing activity builds and maintains bone
Alcohol (3+ drinks/day)	Yes	Interferes with calcium absorption
Long-term corticosteroid use	Yes	Direct bone-damaging effect

If youre stopping HRT and check one or more of these boxes? Youre in the "pay extra attention" group.

And the smartest move you can make? Get a DEXA scanbefore or soon after stopping. It measures your bone mineral density and gives you a T-score, which tells you where you stand.

No guessing. Just facts.

Protecting Your Bones

Okay, heres the hopeful part.

Yes, the risk goes up after stopping.

But heres what the same study found: After about 10 years, the fracture risk drops below that of women who never used HRT.

In other words? The years you spent on HRT may have given your bones a lasting structural advantageeven after you stop.

Butand this is a big butyou still have to protect yourself during the vulnerable window. That 1- to 5-year gap? Thats when you need to be proactive.

So what can you do?

Your Action Plan

Heres your post-HRT bone protection blueprint:

1. Get a DEXA scan. Seriously. Dont skip this. Its painless, quick, and gives you real data. If your T-score is low, your doctor might recommend medication. If its solid, you can focus on lifestyle. Either way, knowledge is power.

2. Nail your nutrition. Your bones need fuel.

• Calcium: 1,200 mg per day. Thats about three servings of dairy, leafy greens, or fortified foods. If youre not hitting it, a supplement can help.
• Vitamin D: 8001,000 IU daily. Many of us are deficient, especially in winter. Ask your doctor for a blood test to check your levels.
• Protein: Aim for 1.01.2 grams per kilogram of body weight. Its not just for musclesbones need it too.

3. Moveon purpose. Bones respond to pressure. The more you load them (safely), the stronger they get.

• Weight-bearing exercise: Walking, dancing, climbing stairsanything where your feet touch the ground.
• Resistance training: Lifting weights, using resistance bands. Just two sessions a week can make a big difference.
• Balance work: Yoga, tai chi. The goal? Prevent falls. Because 90% of hip fractures happen from a fall.

4. Consider other medicationsif needed. HRT isnt the only game in town.

If your bone density is low, options include:

• Bisphosphonates (like alendronate)
• Denosumab (Prolia), a twice-yearly injection
• SERMs like raloxifene, which mimic estrogen on bone
• Anabolic drugs like teriparatide, which actually build new bone (for severe cases)

These arent scary. Theyre tools. And if youre stopping HRT, they might be the next chapter in your bone health story.

5. Fall-proof your home. This sounds small, but its huge.

• Remove loose rugs.
• Add grab bars in the bathroom.
• Improve lightingespecially on stairs.

Its not about living in fear. Its about living wisely.

Should You Stay on HRT?

This is the big question, right?

Can you keep taking HRT just for your bones?

Heres the truth: Most guidelines dont recommend staying on HRT solely for bone protectionunless youre still having symptoms.

Why? Because HRT does come with risks, especially with long-term use:

• Slightly increased risk of breast cancer (with combined estrogen + progestin)
• Higher risk of blood clots and stroke (especially in women over 60 or smokers)

The sweet spot for HRT? Under age 60 or within 10 years of menopause. Thats when benefits far outweigh risks for most women.

So if youre in that window, still having symptoms, and no contraindications? Continuing HRT may make perfect sense.

But if youre symptom-free and over 60? Your doctor will likely suggest transitioning to other bone-protective strategies.

Beyond HRT

The good news? You have options. HRT is powerful, but its not the only way to protect your bones.

Option	How It Works	Best For
Bisphosphonates	Slow bone breakdown	High fracture risk, low BMD
Denosumab (Prolia)	Strong protection, injection every 6 months	Cant take oral meds
SERMs (e.g., raloxifene)	Mimic estrogen on bone, not breast	Some breast cancer risk reduction too
Anabolics (e.g., teriparatide)	Actually build new bone	Severe osteoporosis or fractures
Lifestyle + Nutrition	Foundation for everything	Everyoneno matter what

Think of HRT as one chapter in your bone health journeynot the whole book.

Talk to Your Doctor

At the end of the day, this isnt a decision to make alone.

Bring these questions to your next appointment:

1. "Does my bone density suggest Im at risk for fractures?"
2. "If I stop HRT, when should I get a follow-up DEXA scan?"
3. "Are there osteoporosis meds that might work for me if I stop?"
4. "Could we taper HRT slowly to lower fracture risk?"
5. "What lifestyle changes should I prioritize for my bones?"

Write them down. Bring your list. Your doctor is your partner in this.

Final Thoughts

HRT has given you more than relief from hot flashes. Its helped safeguard your bones during a critical time.

And now, as you consider stopping, youre not just making a decision about medication. Youre making a decision about your long-term strength, mobility, and independence.

Its okay to take your time. To ask questions. To get a second opinion.

Because your bones? Theyre not just holding you up. Theyre helping you live fullydancing at weddings, playing with grandkids, hiking that trail youve always wanted to try.

Youve already taken great care of yourself. Now, its time to keep that momentum going.

Talk to your doctor. Know your risk. Make a plan.

Youve got this.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.