Does hormone therapy protect bones after menopause? For many women, yes, and here is what we found: the 2022 hormone therapy position statement from The North American Menopause Society (now The Menopause Society) supports it. That statement rates the benefit-risk ratio as favorable for preventing bone loss in women younger than 60, or within 10 years of menopause onset, who have no contraindications.
How fast do bones change after menopause?
The Menopause Society press release says you can lose 10% to 20% of bone density in the first five to seven years after menopause. That release lists weight-bearing and resistance exercise, adequate calcium and vitamin D, and hormone therapy among methods it calls proven to help protect bone health. It also says standard estrogen therapy significantly lowers the risk of spine and hip fractures. Your clinician can help you work out how much exercise, calcium and vitamin D fit your situation.
What changed with the FDA boxed warning in 2025?
In November 2025, the U.S. Food and Drug Administration requested removal of boxed warning statements about heart disease, breast cancer and probable dementia from hormone therapy labels, according to the Office on Women’s Health menopause page. In February 2026, the FDA approved the first updated labeling. The FDA consumer update says the agency did not request removal of cardiovascular disease and breast cancer risks from the Warnings and Precautions section. It also says the boxed warning for endometrial cancer is not being removed for systemic estrogen-alone products.
A January 2026 review in Annals of Medicine and Surgery says the FDA cited outdated interpretations of early Women’s Health Initiative findings, and that the boxed warnings dated from 2003.
Does adding testosterone to estrogen protect bone?
Short answer: testosterone for bone is still investigational, so we would treat the early findings with caution. A Menopause Society press release describes a small study of 51 women, followed for an average of 4.1 years. The work was reported for a presentation at the Society’s 2026 Annual Meeting in San Diego, October 20 to 24, 2026. The release does not cite a published full paper.
What the study measured
The women received estrogen therapy for a mean of 3.5 years and estrogen plus testosterone for a mean of 3.1 years. DEXA scans measured bone mineral density at baseline, after at least one year of estrogen alone, and after at least one year of estrogen plus testosterone. According to the release:
- Estrogen alone did not show significant increases in T-scores at any location.
- Estrogen plus testosterone significantly increased T-scores at the lumbar spine.
- Femoral neck and hip T-scores remained stable across both therapy periods.
The researchers concluded that testosterone may exert a synergistic effect with estrogen on trabecular bone, especially at the spine. The study measured T-scores, not fractures. The release does not report the size of the T-score change, the testosterone dose, product or route, the estrogen type, whether women were randomized, or whether there was a control group.
Why a score that does not rise is not the same as preventing loss
The estrogen-alone result in this study is that T-scores did not rise significantly. A score that does not rise is not the same as a score that was protected from falling. The 2022 statement’s claim is about preventing bone loss, which is a different measure. Read the two results separately.
What the 2019 consensus says about testosterone and bone
The 2019 global consensus position statement on testosterone therapy for women came before this study. It was endorsed by societies including the International Menopause Society, The Endocrine Society and the European Menopause and Andropause Society. The 2019 consensus says the available data do not support an effect of testosterone on bone mineral density at the spine, total hip or femoral neck at 12 months, and calls for adequately powered randomized trials. It also says there are insufficient data for using testosterone for any other symptom, condition or disease prevention.
What are the side effects of testosterone in women?
The 2019 consensus says that mild increases in acne and body or facial hair growth are associated with testosterone in some women. It reports no association with alopecia, clitoromegaly or voice change. It says oral testosterone is associated with adverse lipid profiles and is not recommended. A nonsignificant trend toward more deep venous thrombosis was seen, and the role of concurrent estrogen cannot be excluded. It also says short-term transdermal testosterone does not appear to affect breast cancer risk, that data on long-term breast cancer risk are insufficient, and that “the safety of long-term testosterone therapy has not been established.” At the time, it notes, no female testosterone product was approved by a national regulator.
How do the bone options compare?
Each option has a different body of research behind it. The table shows what the named sources report each option does for bone and where the limits are.
| Option | What it is shown to do for bone | Limits named in the sources |
|---|---|---|
| Estrogen therapy (hormone therapy) | The 2022 position statement rates the benefit-risk ratio as favorable for prevention of bone loss in women younger than 60 or within 10 years of menopause onset. The Menopause Society release says standard estrogen therapy significantly lowers the risk of spine and hip fractures. The FDA says approved hormone therapies “may reduce chances of getting osteoporosis.” | The favorable ratio applies to women with no contraindications. The 2022 statement says treatment should be individualized, with periodic reevaluation. Several companies have changed their labels so far; check the current label for your product. |
| Adding testosterone to estrogen (investigational for bone) | In the 51-woman study, estrogen plus testosterone significantly increased lumbar spine T-scores. Femoral neck and hip T-scores were stable. | Small meeting presentation. It measured T-scores, not fractures. The release does not report dose, product, route or randomization. The 2019 consensus calls for adequately powered randomized trials. |
| Exercise (weight-bearing and resistance) | The Menopause Society release lists it among methods it calls proven to help protect bone health. | The release does not report how much exercise or what size of bone effect it gives. |
| Calcium and vitamin D | The Menopause Society release lists adequate calcium and vitamin D among methods it calls proven to help protect bone health. | The release does not report amounts or how these work alongside the other options. |
These options are not interchangeable. Hot flashes and bone protection are related goals, but they are separate. The 2022 statement covers both and calls for individualized treatment. For symptoms, ages and care options across the menopause stages, see the Menopause Stages Guide. For calcium and vitamin D, see vitamin d and bone health and best calcium supplement for bone health.
What to bring to the conversation
These are points worth having ready for a visit with a clinician who can weigh them against your history:
- Your age and the number of years since your menopause.
- Your bone density results, including the T-scores at the spine, femoral neck and hip.
- Any contraindications, since the 2022 statement’s favorable ratio depends on having none.
- Whether hot flashes or other symptoms are part of the decision.
- The current FDA label for each option you are weighing.
For a fuller list, see preparing for an integrative health visit.
Bottom line: The 2022 position statement rates hormone therapy as favorable for preventing bone loss in many women after menopause. Testosterone for bone is still under study, and the new study measured T-scores in 51 women, not fractures. In November 2025 the FDA requested removal of boxed warning statements about heart disease, breast cancer and probable dementia. Several companies have changed their labels so far, and the endometrial cancer boxed warning for systemic estrogen-alone products was not part of the request. The current label for a specific product is the place to check.
By the Integrative Health Evidence Guide Team
This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.