Comparative Effects of Hormone Replacement Therapy and Exercise on Bone Health in Postmenopausal Women: A Systematic Review.

Postmenopausal women are at increased risk of bone loss and fractures. This review compares hormone replacement therapy (HRT) and weight-bearing exercise in their ability to preserve bone mineral density (BMD), a key factor in osteoporosis prevention. A systematic review of HRT and weight-bearing exercise therapy in postmenopausal women was conducted from February 24, 2025, to April 5, 2025, across six electronic databases. A full-text screening was completed by two independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six studies were included according to the inclusion criteria, such as publication date, study format, intervention type, primary outcome, and follow-up duration. Data was extracted using Microsoft Excel (Microsoft Corp., Redmond, WA, USA), and a risk-of-bias assessment was completed. Postmenopausal women may benefit from HRT, as there were greater improvements in BMD than exercise therapy alone and a decreased risk of fracture at sites such as the hip and vertebrae. Exercise interventions, particularly resistance-based or mixed-loading programs, also demonstrated improvements in BMD, although results varied depending on the type and intensity of exercise. Findings were varied and not uniformly superior to either intervention alone. There is also limited evidence evaluating the possible additive benefits of combined therapy. Additionally, discontinuing HRT after beginning it resulted in a decline in BMD, suggesting discontinuation is non-neutral. Both HRT and weight-bearing exercise therapy were associated with improvements in BMD in postmenopausal women, with HRT resulting in greater increases than exercise alone. Exercise remains an important non-pharmacologic strategy, and combination therapy may provide an additive benefit, particularly at high-risk fracture sites such as the lumbar spine and hip, although further research is needed to clarify these effects.