Introduction/Objective: The purpose of this systematic review was to determine the effectiveness of HRT on bone loss in postmenopausal women. It is thought that the use of HRT slows bone loss, and has a beneficial effect on the bone mineral density of women, thus preventing fractures.

Methods: All randomized controlled trials (RCTs) in which treatment with HRT (opposed and unopposed) was compared to control. The primary outcome was bone mineral density/content (BMD/C), other outcomes included the number of fractures on x-ray of hip, vertebrae and wrist. A comprehensive literature review was conducted using MEDLINE supplemented by manual reviews of bibliographies. Quality assessment and data extraction was carried out by two independent reviewers.

Results: Thirty-five RCTs were identified. Results vary by area of bone measurement and methods of measurement. In particular, studies evaluating the lumbar spine for unopposed and opposed estrogen (primary prevention) using DPA and Dexa, the pooled weighted mean difference based on 16 trials (354 treated patients, and 355 controls) is 4.930 and 95% Cl (4.263, 5.598) and secondary prevention based on 7 trials (140,139) is 8.722 and 95% Cl (7.708, 9 736). Femoral Neck based on 2 trials (46,50) is 3.372 and 95% Cl (1.636, 5.108) and based on 1 trial (32,33) is 2.320 and 95% CI (-0.713, 5.353). Fore-arm based on 14 trials (310,300) is 3,483 and 95% Cl (3.096, 8.70) and based on 3 trials (57,61) is 3.073 and 95% Cl (0.612, 5.534).

Discussion: In conclusion, controlled clinical trials have demonstrated that HRT is efficacious in halting bone loss in postmenopausal women.