Menopausal Hormone Therapy and Fracture Risk: What 25 Years of Data Finally Prove

In an ideal world, there would be a therapy that cools the hot flashes, helps you sleep through the night, lifts your mood, keeps your bones strong, and even supports how your skin, brain, and heart age. A therapy that takes the hardest stretch of menopause and makes it livable, while also protecting health down the line.

In an ideal world, it already exists.

Hormone replacement therapy, or HRT, has been available for decades. So why doesn’t every woman who needs it get it? Because of one study, released over 20 years ago, that flipped the conversation.

The headlines were scary. Cancer. Clots. Heart disease. They spread faster than any calm discussion in a clinic ever could. Prescriptions for HRT plummeted, and the stigma hasn’t really left.

Now, the largest study yet — 25 years of follow-up, nearly 650,000 women — delivers a different message. It shows that HRT doesn’t just help while you’re on it. It changes the fracture-risk curve for decades, giving women long-term bone protection that lingers even after stopping.

Decades Later, The WHI Shadow Still Shapes Care

In 2002, the Women’s Health Initiative (WHI) released its hormone therapy findings. The trial was stopped early, and the headlines hit hard: higher risks of breast cancer, blood clots, heart disease, and stroke. Overnight, hormone therapy went from frontline treatment for menopause to a therapy many doctors avoided.

What those headlines never explained was who the women in the study actually were. The average participant was 63 years old—well past the typical age of starting hormone therapy—and already at higher baseline risk for cardiovascular disease. Most were started on a single oral regimen, not the many tailored options available today. The results were generalized to every woman, even though the study design made that leap shaky from the start.

The impact was massive.

Within a year, hormone therapy prescriptions dropped by 46%. Estrogen-only use fell by 28%. Women who were in their 40s and 50s — those who stood to benefit most — were suddenly left with few options and a culture of fear that still shapes care two decades later.

That’s why the new evidence matters.

The WHI left a shadow that never lifted, but the largest dataset to date changes the view. With millions of women tracked over 25 years, the findings show what got overlooked: hormone therapy eases symptoms in the moment and leaves behind long-term protection that reshapes how women age.

The Largest Study Yet Shows Why Women Still Need HRT

Researchers pulled from two of the UK’s largest health databases and followed women for as long as 25 years. The study included 648,747 women who had a first fracture, each matched to controls of the same age and practice, adding up to more than 3 million women in total. That kind of scale is rare in women’s health.

What the data show is striking:

• During therapy: Women on HRT had about a 25% lower fracture risk.
• After stopping: Within the first 1–10 years, fracture risk rose sharply—sometimes higher than women who had never used therapy.
• Beyond 10 years: The curve shifted again. Past users carried a lower fracture risk than never-users, even decades later.

Hormone therapy and longevity are linked.

HRT takes care of the symptoms and gives bones a kind of lasting backup. That benefit doesn’t disappear when therapy stops.

The catch is the first years after coming off it — fracture risk shoots up, and without a plan in place, women end up exposed at the very time they need protection most.

Fracture Risk Isn’t Flat — It Bends With Biology

The new study reveals that fracture risk doesn’t move in a straight line. It bends, depending on how therapy is used and when it stops.

• Regimen: Women on estrogen-only therapy and those on estrogen–progestogen combinations followed slightly different paths. Both lowered risk during use, but the size and timing of the spike after stopping varied.
• Duration: The longer women stayed on therapy, the more it reshaped the curve. Short-term use carried a sharper rebound after discontinuation. Longer use softened that spike and left a stronger long-term advantage.
• Route: Oral therapy comes with more vascular concerns than transdermal delivery, which can change the overall risk profile when weighing benefits for bone against other health factors.

Around age 50, women are in the best window to start HRT. It may protect bone and support heart health. Some studies even suggest it may help with brain fog and memory, and all of that comes on top of improving your quality of life.

What To Do Before A Planned Stop

Before stopping HRT, check where you stand now, setting up safeguards, and knowing how you’ll be monitored once therapy tapers.

Here’s how that process often looks in clinic:

1. Baseline check: Your doctor may order a DXA scan (dual-energy X-ray absorptiometry) to measure bone density and establish a baseline before tapering.
2. Route review: Some physicians transition clients to a skin patch during tapering, since transdermal delivery may carry fewer vascular risks.
3. Backup protection: Depending on your results, your doctor may recommend bone-protective medications such as bisphosphonates or denosumab once HRT is stopped.
4. Lifestyle foundation: Your provider will likely emphasize weight-bearing exercise, calcium and vitamin D intake, and limiting alcohol or tobacco to keep bones strong.
5. Fall safety: Doctors often review fall risks, like checking vision, footwear, and home hazards, since even small slips can lead to fractures.
6. Follow-up plan: A clear schedule for repeat DXA scans and fracture-risk reviews is usually set so changes are tracked over time.

One of the side effects of stopping HRT suddenly is a sharper rebound in symptoms and a spike in fracture risk. The safer path is to taper with a plan, keep safeguards in place, and know how your progress will be monitored.

How Should We Talk About Risk Now?

Too often, women hear blanket warnings that don’t match their reality. The new data make it clear: risk is individual.

• Short term vs. long term: The real hazard is the first 1–10 years after stopping HRT, when fracture risk jumps. After that, the curve bends back down, leaving past users better protected than women who never used therapy.
• Who was studied matters: The WHI subjects were, on average, 63 years old when therapy began. That age alone changes the risk profile compared to starting around 50.
• Risk math is personal: The question isn’t simply whether HRT is “safe.” It’s how to choose hormone therapy that fits your biology — your age, when you start, how long you stay on, the dose, and the delivery method.

Clients deserve counseling that separates fear from biology. Risk is real, but it needs to be explained in context — with numbers that apply to you, not someone twenty years older in a headline.

Stakes Are Higher Than Headlines

Twenty-five years of follow-up and nearly 650,000 women later, we’re seeing the value of hormone therapy for bone health. Risk drops while on therapy, spikes after stopping, and then bends back down to long-term protection.

The real takeaway is that women can no longer be guided by outdated fears.

Decisions need to be grounded in current evidence, timing, and a clear plan for the years after therapy ends.

Clarity Starts With Data

At Yunique Medical, we never push clients into protocols. We begin with diagnostics: full labs, bone scans, and risk modeling to see exactly what your biology is doing. From there, we build a plan that fits your goals and prepares you for the long term.

• What’s being overused, under-converted, or chronically triggered
• Where systems are compensating instead of resolving
• Whether the body is in a state to respond to intervention — or needs restoration first

We don’t fast-track clients into therapies. We map what’s happening biologically, then decide what needs to change and what doesn’t.

Our Services

We offer a wide range of services to support your wellness journey, including:

• Hormone Optimization
• Infusion Therapy
• Weight Loss Programs
• Cellular & Functional Medicine
• Precision Longevity
• HeartFit Program
• Sexual Enhancement
• Peptide Therapy
• HOCATT Biohacking

Our Locations

You can find us here:

• Port Orange, FL
• Lady Lake, FL (formerly Fruitland Park Office)
• Ocala, FL

Schedule a consultation to get answers built on your data.