New ENDO 2026 data: menopausal hormone therapy cuts low bone-density risk by 69% — what Canadian patients should know

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

A retrospective cohort study of 387 postmenopausal women, presented at the Endocrine Society's ENDO 2026 conference on August 26, 2026, found that women using menopausal hormone therapy (MHT) had approximately 69% lower risk of developing low bone mineral density (defined as osteopenia or osteoporosis) in the spine and hip compared to non-users. For Canadian patients already navigating the decision about MHT for symptom relief, this data adds bone protection to the list of potential benefits that a physician or menopause specialist can weigh against individual risk.

The study was led by Diego Espinoza-Peralta, MD, MSc, Vice President of the Mexican Society of Nutrition and Endocrinology and principal investigator at Investigación Médica Sonora (INMEDS) in Mexico. Participants underwent dual-energy X-ray absorptiometry (DXA) scans between 2021 and 2025. Roughly one-third of the cohort (33%) used MHT; the remaining 67% did not. The 69% risk reduction persisted after researchers controlled for age, time since menopause, vitamin D levels, smoking status, and other health conditions, suggesting the association is not simply explained by healthier baseline characteristics among MHT users.

What this means in Canada

MHT products are widely available in Canada through Health Canada-approved formulations. Common options include estradiol (sold in Canada as Estrace in oral form and Estradot or Climara as transdermal patches) combined, where appropriate, with a progestogen such as micronized progesterone (Prometrium). Combination products like conjugated equine estrogens with medroxyprogesterone acetate (Premplus) are also approved. None of these approvals changed as a result of the ENDO 2026 presentation; this is conference data, not a regulatory decision.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has previously recognized MHT as an effective option for managing menopausal symptoms and has acknowledged its role in bone health, though the SOGC has not yet issued a position statement specifically responding to the ENDO 2026 findings. The Menopause Society (formerly the North American Menopause Society) has long stated that MHT is appropriate for bone protection in recently menopausal women at elevated fracture risk, and that position predates this study.

Provincial drug coverage for MHT varies. In Ontario, some MHT formulations are listed on the Ontario Drug Benefit (ODB) formulary for eligible recipients, but coverage is not universal. In Quebec, the Régie de l'assurance maladie du Québec (RAMQ) covers select MHT products under its public drug plan. British Columbia's PharmaCare and Alberta's Prescription Drug Program (AHCIP) similarly list certain formulations, though patients should confirm specific product coverage with their pharmacist. Out-of-pocket costs for a monthly supply of transdermal estradiol patches typically range from roughly CAD $20 to $60 depending on brand and province, before any plan coverage.

For Canadians without a specialist nearby, virtual menopause care is available through platforms including Cleo (a Canadian women's-health platform), Felix, Maple, and Telus Health, as well as Science and Humans (scienceandhumans.com), a Canadian hormone-health platform. US-based platforms such as Midi Health, Hone Health, and Winona do not serve Canadian patients.

Why this matters

Osteoporosis affects an estimated 2 million Canadians, according to Osteoporosis Canada, and women account for the large majority of cases. Bone loss accelerates sharply in the years immediately following menopause, when estrogen levels fall. Osteopenia (lower-than-normal bone density that has not yet reached the osteoporosis threshold) and osteoporosis both raise the risk of fragility fractures, which can lead to disability and loss of independence, particularly hip fractures in older women.

For years, many clinicians and patients pulled back from MHT following the 2002 Women's Health Initiative (WHI) trial, which raised concerns about breast cancer and cardiovascular risk. Subsequent reanalysis of WHI data and a body of later research have substantially refined that picture, particularly for women who begin MHT within ten years of menopause or before age 60. The ENDO 2026 study adds to that evolving body of evidence by quantifying a bone-density benefit in a real-world cohort with DXA-confirmed outcomes.

Espinoza-Peralta framed the shift plainly: the conversation is moving from "avoid if possible" to "reconsider in the right patient."

What Canadian patients should know

If you are postmenopausal and concerned about bone density, the first step is a DXA scan. In Canada, DXA scans are covered by provincial health insurance for patients who meet clinical criteria, typically women over 65 or younger postmenopausal women with risk factors such as a prior fracture, low body weight, or a family history of osteoporosis. Your family physician or internist can order the scan and refer you to a gynecologist or endocrinologist if MHT is being considered.

MHT is not appropriate for everyone. Women with a personal history of estrogen-receptor-positive breast cancer, unexplained vaginal bleeding, active liver disease, or a history of blood clots may not be candidates. These contraindications have not changed based on the ENDO 2026 data. The decision involves weighing symptom burden, fracture risk, cardiovascular profile, and personal preference, ideally with a clinician who is current on menopause guidelines.

For women who cannot or choose not to use MHT, other Health Canada-approved options for osteoporosis prevention include bisphosphonates such as alendronate (Fosamax) and denosumab (Prolia), though these are generally used for treatment rather than prevention in the early postmenopausal period.

Limitations and open questions

The ENDO 2026 study is retrospective, meaning it looked backward at existing records rather than randomly assigning women to MHT or no MHT. That design cannot fully rule out selection bias: women who chose MHT may differ from non-users in ways that also protect bone, even after statistical adjustment. The cohort of 387 women is relatively small, and the study was conducted at a single centre in Mexico, so how well the findings translate to Canadian populations with different demographics, dietary patterns, and healthcare access is not established.

The data have been presented at a conference but, as of publication, have not appeared in a peer-reviewed journal. Health Canada has not issued any new guidance on MHT and bone density in response to this presentation. The SOGC has not yet commented on these specific findings. Larger, prospective, ideally randomized studies would be needed before this single figure (69%) should be treated as a definitive estimate.

What the study does do is add weight to a direction of evidence that Canadian clinicians and patients can bring to an informed conversation.

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Editorial note

Hormone Journal articles are written by our editorial team and reviewed against published clinical guidelines, with a focus on Canadian patient access. We do not promote specific clinics or providers.